Over the past 40 years, we have observed the introduction of several medical therapies
for heart failure with reduced ejection fraction (HFrEF). More recently, effective
medical therapy (Goal Directed Medical Therapy, or GDMT)for patients suffering from
heart failure with preserved ejection fraction (HFpEF) has been identified in the
form of sodium/glucose cotransporter 2 inhibitors (SGLT2 inhibitors)(
1
). There has also been recognition that timely and aggressive GDMT titration to target
doses leads to better outcomes(
2
). This becomes more complex as the number of drug up titrations increases (such as
with beta blockade at 4 doses), and corresponds to lower target dose achievement,
even in Canadian centres of excellence(
- Kimmoun A
- Cotter G
- Davison B
- Takagi K
- Addad F
- Celutkiene J
- et al.
Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15,
of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized,
parallel-group study.
Eur J Heart Fail. 2019; 21: 1459-1467
3
,
4
). Thus, there is interest in use of simplified dosage regimens, provided there is
no significant benefit left unrealized(
5
). In order to define this tension, one must be able to identify the optimal dosage
for any given medication.To read this article in full you will need to make a payment
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References
Mancini GBJ, O'Meara E, Zieroth S, Bernier M, Cheng AYY, Cherney DZI, et al. 2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors for Cardiorenal Risk Reduction in Adults. Can J Cardiol. 2022;38(8):1153-1167.
- Safety, Tolerability and efficacy of Rapid Optimization, helped by NT-proBNP and GDF-15, of Heart Failure therapies (STRONG-HF): rationale and design for a multicentre, randomized, parallel-group study.Eur J Heart Fail. 2019; 21: 1459-1467
- The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Inpatients With Heart Failure.CJC Open. 2022; 4: 636-643
- Use of Guideline-Directed Medical Therapy in Patients Aged ≥ 65 Years After the Diagnosis of Heart Failure: A Canadian Population-Based Study.CJC Open. 2022; 4: 1015-1023
- A Novel Approach to Medical Management of Heart Failure With Reduced Ejection Fraction.Can J Cardiol. 2021; 37: 632-643
- Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial.Lancet. 2009; 374: 1840-1848
- Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.N Engl J Med. 2015; 373: 2117-2128
- CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction.Can J Cardiol. 2021; 37: 531-546
- Efficacy and safety of empagliflozin at different doses in patients with type 2 diabetes mellitus: A network meta-analysis based on randomized controlled trials.J Clin Pharm Ther. 2022; 47: 270-286
- Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis.Diabetes, Obesity and Metabolism. 2016; 18: 783-794
- Randomized, Double-Blind, Pilot Study Comparing 10, mg and 25 mg of Empagliflozin in Heart Failure With Preserved Ejection Fraction.Canadian Journal of Cardiology. 2023; https://doi.org/10.1016/j.cjca.2023.01.019
- Different Doses of Empagliflozin in Patients with Heart Failure with Reduced Ejection Fraction.Int Heart J. 2022; 63: 852-856
- Comparison of 10 mg and 25 mg of Empagliflozin in Patients With Heart Failure With Reduced Ejection Fraction.Can J Cardiol. 2022; 38: 1641-1642
- Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF).Circulation. 2021; 143: 516-525
- Associations of Empagliflozin With Left Ventricular Volumes, Mass, and Function in Patients With Heart Failure and Reduced Ejection Fraction: A Substudy of the Empire HF Randomized Clinical Trial.JAMA Cardiol. 2021; 6: 836-840
- Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE).Lancet. 1997; 349: 747-752
Article info
Publication history
Accepted:
March 2,
2023
Received in revised form:
February 27,
2023
Received:
February 13,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Randomized, Double-Blind, Pilot Study Comparison of 10- and 25-mg Empagliflozin in Patients With Heart Failure With Preserved Ejection FractionCanadian Journal of Cardiology
- PreviewEmpagliflozin not only decreases blood glucose levels, but also can be used to treat heart failure (HF).1,2 A study suggested that empagliflozin 25 mg is preferable to 10 mg for patients with HF with reduced ejection fraction.3 However, it was unclear if there are differences in the effects of 10 mg and 25 mg of empagliflozin on the outcomes of patients with HF with preserved ejection fraction (HFpEF). The main aim of this study was to compare the efficacy of 10 mg and 25 mg of empagliflozin in patients with HFpEF.
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