Key result
Following SGLT2 inhibitor initiation in patients with heart failure, loop diuretic dose reduction occurred empirically in 2.0% of patients, and in 14.0% of patients by 12 months.
Why the study?
Evidence-based recommendations are lacking regarding which patients with heart failure require loop diuretic dose decreases or how to adjust doses upon SGLT2i initiation.
Does SGLT2 inhibitor initiation reduce loop diuretic dose requirements in patients with heart failure?
Observational (n=100)
Does SGLT2 inhibitor initiation reduce loop diuretic dose requirements in patients with heart failure?
In real-world practice, the vast majority of heart failure patients do not require empirical or subsequent loop diuretic dose reduction within the first year of starting an SGLT2 inhibitor.
Routine empiric loop-diuretic cuts at SGLT2i start appear unnecessary; leaves open who later needs down-titration.
Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated cardiovascular benefits in patients with heart failure, many of which take loop diuretics. There are no evidence-based recommendations identifying which patients may require loop diuretic dose decreases or how to adjust loop diuretic doses when SGLT2is are initiated. Objectives: The main objective of this study was to investigate the frequency and degree of adjustments in loop diuretic doses after SGLT2i initiation in patients with heart failure. Methods: In this retrospective evaluation, patients seen in the UCHealth system with a diagnosis of heart failure who were prescribed a loop diuretic before initiation of SGLT2i were identified. We described loop diuretic dose changes at the time of SGLT2i initiation, at 6 months after initiation, and at 1 year after initiation. We also described de-escalation of maintenance medications that can contribute to hypotension at these time points. Data were evaluated using descriptive statistics. Results: A total of 100 patients were included. Loop diuretic dose was reduced empirically upon SGLT2i initiation in 2.0% of patients. Reduction of loop diuretic dose within the first 6 months of starting an SGLT2i occurred in 8.0% of patients. From baseline to 12 months after starting SGLT2i therapy, 14.0% of patients had loop diuretic dose reduction. Conclusions: Most of our patients with HF did not have change in loop diuretic dose after initiation of an SGLT2i. In patients who did have loop diuretic dose reduction, most occurred within 6 months after starting SGLT2i therapy rather than empirically at time of initiation.
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Trudeau et al. (2022) conducted an observational in heart failure (n=100). SGLT2 inhibitor initiation was evaluated on Loop diuretic dose reduction from baseline to 12 months after starting SGLT2i therapy. Following SGLT2 inhibitor initiation in patients with heart failure, loop diuretic dose reduction occurred empirically in 2.0% of patients, and in 14.0% of patients by 12 months.
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