Pillars of Heart Failure Management: Implementation and Outcomes with an Emphasis on SGLT2 Inhibitor and Beta-blockers

Pillars of Heart Failure Management: Implementation and Outcomes with an Emphasis on SGLT2 Inhibitor and Beta-blockers

1)       Heart failure is extremely frequent, often forgotten and fatal in diabetes.

2)   Diabetes changes the cardio-metabolic fingerprints leading to a predisposition to HF, independent of atherosclerotic disease; this effect is exaggerated by coincident renal damage.

3)      Prevention of HF in primary and secondary prevention is essential, and SGLT2 inhibitors demonstrate profound efficacy in this regard-reduced hospitalization for CHF and CV mortality, regardless of existing atherosclerotic CVD or h/o HF or diabetes mellitus.

4)    Beta-blockers-C/I in the past are now the mainstay in the management of stable HF.

5)    Guidelines: ACC/AHA 2021

·      Use of one of the three beta-blockers proven to reduce mortality (such as bisoprolol, carvedilol and sustained release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF unless contraindicated to reduce morbidity and mortality.

6)    Guidelines: ESC 2019

·      A beta-blocker, in addition to an ACE inhibitor, is recommended for patients with stable, symptomatic HFrEF to reduce the risk of HF hospitalization and death.

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