Are SGLT2 inhibitors effective for treating heart failure with mildly reduced ejection fraction?
Heart failure with mildly reduced ejection fraction (HFmrEF) means the heart's pumping ability is mildly reduced, with an ejection fraction between 40% and 49%. SGLT2 inhibitors are a class of medications originally used for diabetes that have shown benefits in heart failure. Research indicates that SGLT2 inhibitors reduce the risk of heart failure hospitalizations and cardiovascular death in patients with HFmrEF, making them an important treatment option.
What the research says
A network meta-analysis of 27 randomized controlled trials involving over 65,000 patients with heart failure with preserved or mildly reduced ejection fraction found that SGLT2 inhibitors reduced the risk of worsening heart failure events compared to placebo 3. This analysis included patients with HFmrEF and showed significant benefits. The DELIVER trial specifically studied dapagliflozin, an SGLT2 inhibitor, in patients with heart failure and ejection fraction greater than 40%, which includes HFmrEF. It found that dapagliflozin reduced the risk of the primary composite outcome (cardiovascular death or worsening heart failure) compared to placebo across all age groups 9. Another meta-analysis of 15 randomized controlled trials including over 28,000 heart failure patients, regardless of ejection fraction, showed that SGLT2 inhibitors reduced all-cause mortality by 14% and heart failure hospitalizations 5. A separate meta-analysis focusing on patients after acute coronary syndrome also found that SGLT2 inhibitors reduced the risk of first heart failure hospitalization by 22% 6. While these studies include patients with various ejection fractions, the benefits consistently apply to those with mildly reduced ejection fraction. Additionally, a small trial in nondiabetic patients with HFmrEF found that dapagliflozin improved heart function as measured by echocardiography after 6 months 11.
What to ask your doctor
- Is an SGLT2 inhibitor like dapagliflozin or empagliflozin appropriate for my heart failure with mildly reduced ejection fraction?
- What are the potential side effects of SGLT2 inhibitors, and how can they be managed?
- How would an SGLT2 inhibitor fit with my current heart failure medications?
- Do I need any monitoring (e.g., kidney function, blood sugar) while taking an SGLT2 inhibitor?
- Are there any reasons I should not take an SGLT2 inhibitor based on my medical history?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.