HFpEF vs HFmrEF management 🏥 via #esc2023 #EBM

🔑 Clinical Trials:

🔹DELIVER (2022) and EMPEROR-Preserved (2021): SGLT2i in EF>40%
🔹PARAGON-HF (2019): ARNI vs ARB in EF>45%
🔹TOPCAT (2014): MRA in EF>45%
🔹CHARM-Preserved (2003): ARB in EF>40%

App 🔗 apps.apple.com/us/app/cardiac…

Cons of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

Session: management of #obesity
🔥Holistic care is key! Listen & help those with obesity seeking support. Exercise, resistance training, diet, weight reduction, lifestyle and psychological input alongside medical therapies (SGLT2i & GLP-1/GP agonists +/- bariatric surgery

Pros of inpatient SGLT2i use. AACE
endocrinepractice.org/article/S1530-…

Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Systematic Review and Network Meta-Analysis

quadruple combination of ARNI, BB, MRA, and SGLT2i provides the largest reduction in the risk of CV death and HHF

jacc.org/doi/10.1016/j.…

🟢Genitourinary Tract Infections in Patients Taking SGLT2I:

👉SGLT2is is associated with an ↗️ risk of GMI but not UTI or necrotizing fasciitis of the perineum (Fournier’s gangrene).

👉 benefits of SGLT2is usually outweigh the risk of treatment-associated GU infections.

👉In

🔴 Contemporary Use & Implications of Beta-Blockers in Ptsw/ HFmrEF or HFpEF: The DELIVER Trial

✅BB use wasn't linked to #worseningHF or #cvDeath . Benefits of #dapa remained regardless of BBs, reassuring their role in Rx HFpEF/ HFmrEF alongside #SGLT2i . bit.ly/4b2jQCQ

NI is in the midst of an evolving non communicable disease long term condition snowstorm.

Previous studies show within just 5yrs of Dx 68% of people with T2D showed signs of LVSD.

1ryCare T2D cohorts needs infiltrated with SGLT2i’s in appropriate patients.For all our sakes.

SGLT2i | Heart failure

Heart failure ➡️ activation of neurohormonal system ➡️ SGLT2 + NH3 revved up ➡️ Na reabsorbed ➡️ less Na at macular densa ➡️ macular densa makes more renin ➡️ increases activation of neurohormonal system 🔄

SGLT2i 🚫 SGLT2/NH3 thus 👉🏼 resets

#HeartFailureDays
#HeartFailureWeek

#SGLT2i in #AcuteHF
#DICTATE_AHF
#Dapa confirmed:
-Effective decongestive effect ✅
-Diuretic & Natriuretic effect ✅
-Significant ⬇️ of mean loop-diuretic dose
-Shorter length of 🏥 ✅
-No AE ✅
🍀 On-top of SGLT2i ⬇️ of ☠️

#Findme
Gregg Fonarow MD

#BalanceDHF Milestone❗️

First pts enrolled in #BalanceDHF RCT studying unique #MRmodulator balcinrenone in combo w #SGLT2i dapagliflozin

Seeking to expand therapeutic options in HF+CKD across the full spectrum of LVEF!

Long way to go, but 💪🏾 global team
classic.clinicaltrials.gov/ct2/show/NCT06…

SGLT2i โหหห มี anti-cancer effects ด้วยเหรอ 😮

Effects of #GDMT across Kidney Function Spectrum

✅ #BB : consistent benefit to eGFR 30
✅ #ARNI : consistent benefit to eGFR 30
✅ #SGLT2i : consistent benefit to eGFR 20
❌ #SteroidalMRA : ↓ benefit & worse safety at lower eGFR

New strategies to block MR axis in HF & CKD needed!

11) So what was the result of CREDENCE❓

⤵️ primary composite outcome (end-stage kidney disease, doubling creatinine, death from kidney/

⤵️ end-stage kidney disease

⚠️ No increase in amputation or fractures

👉 It worked! SGLT2i ⤵️ 'HARD' outcomes (well canagliflozin at least)

Los SGLT2i aumentan el suministro cardíaco de O2 y energía y disminuyen el trabajo cardíaco y citotoxicidad. Hay menor formación de toxinas como el p-cresol. La pérdida urinaria de calorías y glucosa aumenta lipólisis, por lo tanto, reduce la masa grasa.

doi.org/10.1093/ndt/gf…

もう読んだ人も多いかもですが、KDIGOのCKDガイドライン2024読んで個人的に印象に残った点をブログにまとめてました✍️SGLT2iやGLP-1、MRAの話題からRASiをいつまで続けるべきか？など面白い内容がいっぱいでした😊ikuji-doctor.com/kdigo-ckd-guid…

【CKD Stage 5へのSGLT2iの効果（Ann Intern Med）】

台湾,国民健康保険DB
CKD Stage 5の2型DM 2.3万人ずつ
SGLT2i使用 vs 未使用で

透析 HR 0.34［0.27～0.43］
心不全入院 HR 0.80［0. 73～0.86］
MI HR 0.61［0.52～0.73］

ただ全死亡 HR 1.11［0.99～1.24］

pubmed.ncbi.nlm.nih.gov/38684099/

Welcome to day 1 of the Scripps Clinical Advances in Heart Failure, Arrhythmias, & Cardiogenic Shock Symposium! 🫀⚡️Rajeev Mohan gave a comprehensive update on HFpEF treatment, including SGLT2i’s & device-based therapies currently in clinical trials!

I wonder 🤔 if SGLT2I could be a treatment option in Afib.
Trialists, please randomise 😅

16) Despite RASi & SGLT2i #ResidualRisk remains in terms of adverse kidney & 💔 outcomes.

🔹So onto Pillar Three

🔸Mineralocorticoid receptor agonists

👉action in #DKD include:
⤵️Inflammation
⤵️Fibrosis
⤵️ BP
⚠️⤴️ potassium
⚠️⤴️ sexual dysfunction in ♂️