A Review of the Current Literature Regarding Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Preserved Ejection Fraction and Timing of Initiating Therapy
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a growing public health burden that now accounts for nearly half of all HF diagnoses in the United States. Modern classifications of HF divide patients into HFpEF and HF with reduced ejection fraction (HFrEF). Historically, diagnosis has relied on the Framingham Heart Failure Diagnostic Criteria, which incorporates clinical signs and symptoms including pulmonary edema, jugular venous distention, orthopnea, S3 gallop, cardiomegaly, peripheral edema, dyspnea on exertion, and tachycardia. Contemporary definitions of HF further incorporate objective evidence such as elevated natriuretic peptide levels, cardiopulmonary congestion, and echocardiographic findings including preserved left ventricular ejection fraction and evidence of diastolic dysfunction. HFpEF predominantly affects older adults and is strongly associated with hypertension, obesity, diabetes mellitus, coronary artery disease, atrial fibrillation, and chronic kidney disease. Despite advances in management, HFpEF continues to be associated with substantial morbidity, mortality, recurrent hospitalization, and healthcare utilization. Therapeutic options for HFpEF have historically been limited, with few interventions demonstrating meaningful reductions in hospitalization or cardiovascular mortality. However, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a promising cornerstone of therapy. Initially developed for glycemic control in patients…
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