What about HFmrEF or HFpEF?

The mainstay of treatment for HFmrEF and HFpEF has been symptom management for congestion with diuretics and management of comorbidities. However, as mentioned, recent trials with SGLT2 inhibitors have led to an extension of the dapagliflozin licence across the spectrum of chronic heart failure. Dapagliflozin is now recommended by NICE as an option for both HFmrEF and HFpEF. At the time of writing empagliflozin was still under review.

Conclusion

Heart failure is common and carries significant mortality and morbidity that can be reduced with use of recommended treatments up-titrated to doses that patients can tolerate. However, many remain undiagnosed and undertreated. There are many aspects of care that community pharmacists can implement to improve symptoms, medicines optimisation and adherence, support patient self-management and increase quality of life.