Heart failure specialist Dr Ileana Piña discusses what she likes about the 2023 ESC focused update to the heart failure guidelines.
, in HFpEF — defined, as I said, as 40% or 45% or greater, not necessarily 50% —with excellent point estimates that just line up, one on top of the other. It doesn't matter if patients have diabetes or not; the results are exactly the same.
This has been so promising that I am not surprised that the Europeans elevated the SGLT2 inhibitors to a class 1A indication. In the US in 2022, we thought we were really way ahead by calling it a class 2A indication. Well, now it's a class 1A indication in Europe, and I have a feeling that the American Heart Association and the American College of Cardiology are going to start talking about an update because the data are so strong.
When? I have no specific day that I start it. I used to try to do a good diuresis first, get the patients somewhat decongested, and then start it. I don't want to deprive the patients of the benefits of these drugs that happen very early by waiting until the patients are in the outpatient setting. In the United States, we've had some issues with coverage of some of these drugs. In my institution, we now have both on the formulary, and I pick the drug depending upon the patient's coverage. Medicare pretty much covers most of them. If the patient is older but not yet a Medicare patient, they may have a very large copay.
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