Heart failure drug treatment: the fantastic four
Abstract
This editorial refers to ‘Influence of neprilysin inhibition on the efficacy and safety of empagliflozin in patients with chronic heart failure and a reduced ejection fraction: the EMPEROR-Reduced Trial’†, by M. Packer et al., on page 671. Heart failure with reduced ejection fraction (HFrEF) requires a multimodal treatment with combination of several drugs as the cornerstone for symptomatic and prognostic improvement in all patients.1,2 Drug therapies such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor/neprilysin inhibitors (ARNIs; sacubitril/valsartan), beta-blockers, and mineralocorticoid receptor antagonists (MRAs) provide incremental benefit with marked reduction in all-cause mortality, cardiovascular mortality, all-cause hospitalizations, and hospitalizations for heart failure.3 Recently, the sodium–glucose co-transporter 2 (SGLT2) inhibitors dapagliflozin (DAPA-HF) and empagliflozin (EMPEROR-Reduced) showed a highly significant and clinically relevant reduction in mortality and heart failure hospitalizations, and improvement of quality of life when added to current standard drugs in patients with HFrEF.4,5 Importantly, outcomes were ameliorated to a similar extent in patients with and without diabetes. The question remained, however, of whether the nominally ‘standard’ heart failure drug treatment in the SGLT2 inhibitor trials corresponded to a ‘real’ modern guideline-directed medical therapy. While in both DAPA-HF and EMPEROR-Reduced the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 74 participants or records.
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