The 2021 year in review summarizes the new universal definition of heart failure, updated ESC guidelines, and recent evidence for SGLT2 inhibitors and other therapies in HFrEF and HFpEF.
This review highlights key 2021 advancements in heart failure, notably the universal definition of HF, updated ESC guidelines, and the emergence of SGLT2 inhibitors as foundational therapy for both HFrEF and HFpEF.
In the year 2021, the universal definition and classification of heart failure (HF) was published that defines HF as a clinical syndrome with symptoms and/or signs caused by a cardiac abnormality and corroborated by elevated natriuretic peptide levels or objective evidence of cardiogenic congestion. This definition and the classification of HF with reduced ejection fraction (HFrEF), mildly reduced, and HF with preserved ejection fraction (HFpEF) is consistent with the 2021 ESC Guidelines on HF. Among several other new recommendations, these guidelines give a Class I indication for the use of the sodium-glucose co-transporter 2 (SGLT2) inhibitors dapagliflozin and empagliflozin in HFrEF patients. As the first evidence-based treatment for HFpEF, in the EMPEROR-Preserved trial, empagliflozin reduced the composite endpoint of cardiovascular death and HF hospitalizations. Several reports in 2021 have provided novel and detailed analyses of device and medical therapy in HF, especially regarding sacubitril/valsartan, SGLT2 inhibitors, mineralocorticoid receptor antagonists, ferric carboxymaltose, soluble guanylate cyclase activators, and cardiac myosin activators. In patients hospitalized with COVID-19, acute HF and myocardial injury is quite frequent, whereas myocarditis and long-term damage to the heart are rather uncommon.
“The crowning SGLT2 inhibitor achievement came with EMPEROR-Preserved, when empagliflozin became the first drug to benefit HF with preserved ejection fraction, achieving something of a holy grail in cardiology.”
Bauersachs et al. (Tue,) conducted a review in Heart failure and cardiomyopathies. Heart failure therapies (SGLT2 inhibitors, etc.) was evaluated. The 2021 year in review summarizes the new universal definition of heart failure, updated ESC guidelines, and recent evidence for SGLT2 inhibitors and other therapies in HFrEF and HFpEF.