Key result
Increased SGLT2i use does not influence prescription rates or dosing of other HFrEF therapies.
Why the study?
Four pharmacological classes are recommended in HFrEF, but trends in dose adjustments of ACEi/ARB/ARNI, beta-blockers, and MRA following the introduction of SGLT2i remained to be evaluated.
Does the increased use of SGLT2 inhibitors affect the prescription rates and dosing of other foundational therapies in patients with HFrEF?
Observational (n=496)
Does the increased use of SGLT2 inhibitors affect the prescription rates and dosing of other foundational therapies in patients with HFrEF?
The integration of SGLT2 inhibitors into HFrEF management did not compromise the prescription or dosing of other foundational therapies, though overall dose optimization remains low.
May support adding SGLT2i without compromising other GDMT in HFrEF; leaves open outcome impact in broader real-world cohorts.
Background & Study Aim In patients with heart failure with reduced ejection fraction (HFrEF), the use of four main pharmacological classes is currently recommended: angiotensin receptor–neprilysin inhibitors (ARNI), preferred over angiotensin–converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), beta–blockers, mineralocorticoid receptor antagonists (MRA), and sodium–glucose co–transporter 2 inhibitors (SGLT2i). The aim of this study was to evaluate trends in prescribed dose adjustments of ACEi/ARB/ARNI, beta–blockers, and MRA over recent years, following the introduction of SGLT2i, in patients enrolled in the PONTE SC/SCA registry. Methods and Results Among the 496 patients with HFrEF enrolled in the registry, both retrospective (2021–2023) and prospective (2024–2025) analyses were performed. Over this period, prescription rates of ACEi/ARB/ARNI (82–89%), ARNI (58–64%), MRA (84–86%), and beta–blockers (93–96%) remained stable, whereas a significant increase in SGLT2i prescription was observed, from 10% to 85%. The increased use of SGLT2i did not affect the dosing of the other pharmacological classes; however, the proportion of patients receiving the maximum recommended dose remained low, particularly for ARNI and ACEi/ARB (Figure 1). Conclusions In the PONTE SC/SCA registry, the increased use of SGLT2i did not influence either prescription rates or dosing of the other recommended drug classes. Nevertheless, these findings highlight the need to increase the proportion of patients treated with ARNI at the maximum recommended dose.Figure 1
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Citarelli et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=496). Introduction of SGLT2i was evaluated on Trends in prescribed dose adjustments and prescription rates of ACEi/ARB/ARNI, beta-blockers, and MRA. The increased prescription of SGLT2i from 10% to 85% did not influence the prescription rates or dosing of other recommended drug classes in patients with HFrEF.
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