In-hospital initiation of sodium-glucose co-transporter-2 inhibitors in patients with acute heart failure.

IF 4.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Failure Reviews Pub Date : 2024-10-15 DOI:10.1007/s10741-024-10446-2

Muhammad Sameer Arshad, Adeena Jamil, Stephen J Greene, Harriette G C Van Spall, Gregg C Fonarow, Javed Butler, Muhammad Shahzeb Khan

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Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiovascular and kidney benefits to patients with heart failure (HF) and/or chronic kidney disease (CKD), regardless of diabetes status and left ventricular ejection fraction (LVEF). Despite robust data demonstrating the efficacy of SGLT-2 inhibitors in both ambulatory and hospital settings, real-world evidence suggests slow and varied adoption of SGLT2 inhibitors among patients hospitalized for HF. Barriers to implementation of SGLT2i may include clinicians' concerns regarding potential adverse events such as diabetic ketoacidosis (DKA), volume depletion, and symptomatic hypoglycemia; or concerns regarding physiologically expected reductions in eGFR. Guidelines lack specific, practical safety data and definitive recommendations regarding in-hospital initiation and continuation of SGLT2i in patients hospitalized with HF. In this review, we discuss the safety of in-hospital SGLT2 inhibitor initiation based on recent trials and highlight the clinical implications of their early use in patients hospitalized for HF.

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急性心力衰竭患者在院内开始使用钠-葡萄糖协同转运体-2 抑制剂。

钠-葡萄糖共转运体-2（SGLT2）抑制剂可为心力衰竭（HF）和/或慢性肾病（CKD）患者带来心血管和肾脏方面的益处，而与糖尿病状态和左心室射血分数（LVEF）无关。尽管有大量数据显示 SGLT-2 抑制剂在门诊和住院环境中均有疗效，但现实世界的证据表明，在因心力衰竭住院的患者中，SGLT2 抑制剂的应用进展缓慢且不尽相同。实施 SGLT2i 的障碍可能包括临床医生对潜在不良事件的担忧，如糖尿病酮症酸中毒（DKA）、容量耗竭和症状性低血糖；或对 eGFR 生理预期下降的担忧。关于高血压住院患者在院内开始和继续使用 SGLT2i，指南缺乏具体、实用的安全性数据和明确的建议。在本综述中，我们将根据最近的试验讨论院内启动 SGLT2 抑制剂的安全性，并强调在心房颤动住院患者中早期使用 SGLT2 抑制剂的临床意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart Failure Reviews 医学-心血管系统

CiteScore

10.40

自引率

2.20%

发文量

审稿时长

6-12 weeks

期刊介绍： Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.