SGLT-2 inhibitors in the management of acute decompensated heart failure

Background. Acute decompensated heart failure (ADHF) is associated with an unfavorable prognosis and low survival of patients.

Aim. Evaluation of the six-month efficacy of early dapagliflozin administration in patients with ADHF with a reduced left ventricular ejection fraction (LVEF) in comparison with standard therapy.

Materials and methods. The results of the six-month follow-up of 122 patients with ADHF with a reduced LVEF (28±6%), who were divided equally into 2 groups: the standard therapy (group 1) and the sodium-glucose cotransporter-2 inhibitor – dapagliflozin (group 2). Dapagliflozin was prescribed at a dose of 10 mg by a mean of 24 (8–44) hours from admission to the hospital. Patients of both groups received intravenous diuretic therapy. The study mainly included male patients (82 and 85.2%, respectively), most patients were classified as NYHA class III (77 and 82%), the groups did not differ with respect to type 2 diabetes mellitus (p=0.335). The parameters were analyzed at the time of inclusion in the study and when ADHF compensation was achieved, and six months after discharge.

Results. The average dosage of intravenous furosemide in group 1 was 60 mg/day, in group 2 – 40 mg/day (p=0.017). Cumulative urine output over first 4 day of hospitalization in group 2 was significantly higher – 9149±2897 ml than in group 1 – 6841±1973 ml. Higher doses of diuretics during hospitalization were required by 42.6% of patients in group 1 and 24.6% of patients in group 2 (p=0.035). The average length of hospital stay were 13 and 8 days, respectively (p<0.001). During the six months follow-up, the number of ADHF hospitalizations were significantly higher in group 1 (p=0.002), additional intake of dapagliflozin had no effect on mortality (p=1). The decrease in NT-proBNP level and increase in LVEF were more significant in group 2 after six months of therapy (p=0.006 and 0.008, respectively). The LVEF delta between admission to the hospital and a visit after six months in group 1 was 4%, in group 2 – 6.5%; p=0.008. At discharge from the hospital and after 6 months of therapy, group 2 patients had a lower rate of pulmonary artery systolic pressure and NYHA class of heart failure (p<0.05).

Conclusion. The results indicate the efficacy of early dapagliflozin administration in patients with ADHF with a reduced LVEF, regardless of diabetes, both at the hospital stage and with long-term follow-up.