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Heart failure, patient management changes

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A weak, “stiff” heart that cannot contract as it should. It is the heart of people with heart failure, a condition of particular concern due to its increasing prevalence and its consequences on quality of life. The number of people with heart failure is in fact constantly growing as a consequence of the increase in the average age of the population: over 70 years, heart failure has an incidence that exceeds 5% and is the most frequent cause of hospitalization. The need for increasingly effective and timely disease management strategies is therefore strongly felt in the scientific community and among patients.

To meet this need, on the occasion of the European Congress of Cardiology, the “Guidelines on heart failure 2021” were presented, the result of the review of the best scientific literature evidences that update those of 2016. Numerous innovations, which outline a path of more timely and effective patient care. The main innovations concern the classification of the disease, which helps to precisely identify the diagnostic and therapeutic needs of each particular manifestation, and drug therapy.

In fact, the new guidelines introduce the use of drugs originally designed for the treatment of diabetes, which in recent years have also shown an effective action against heart failure: some SGLT2 inhibitors are today considered fundamental life-saving drugs for heart failure by begin in patients with reduced ejection fraction at the earliest opportunity. In particular, dapagliflozin was introduced on the basis of scientific evidence of its effectiveness.

From diabetes to the heart

Dapagliflozin is an innovative drug that acts on the renal transport of sodium and glucose. Originally designed and tested for the treatment of diabetes, it has been shown not only to reduce blood sugar but also the severe kidney and heart complications associated with it. Hence the idea of ​​trying it as a medicine for chronic kidney disease and heart failure. In this last case the results were extraordinary, with a significant reduction in the risk of both cardiovascular death and worsening of heart failure episodes, including hospitalization. The phase III DAPA-HF study showed that dapagliflozin, in addition to standard of care, reduced this risk by 26% compared to placebo: in other words, the addition of the drug prevented either death from cardiovascular causes or one hospitalization for heart failure or one urgent visit associated with the disease for every 21 patients treated.

Results that led to the design of further trials to prove the action of dapagliflozin also in patients with preserved ejection fraction decompensation and in patients without type 2 diabetes who had a myocardial infarction. This latter study is the first of its kind as it is randomized and controlled, based on registries and with the purpose of extension of indication. Pending these further results, those obtained so far have so convinced the scientific community that dapagliflozin has been included in the armory of the main options for heart failure.

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