➡️Yes, this combo improved Sxs & reduced CVD death & hosp rates (click here)
💯Correct!
⚡️The HYD/ISDN combo was tested in the A-HeFT trial in an all-AA population with HFrEF.
⚡️More than 80% also had T2D & ~34% had renal insufficiency.
⭐️The vasodilator combo showed improvements in Sxs & reductions in hosp & CVD death rates.
3 recently published studies show pts with HF, T2D, & CKD would benefit from a drug in which class?
⚡️You approve the HYD/ISDN combo but also want to add an SGLT2 inhibitor based on findings from 3 phase III clinical trials published in 2019.
⭐️Empagliflozin could be a good option.
⭐️In the EMPA-REG OUTCOME trial, empagliflozin had lower rates of MACE, CVD & all-cause death, & HF hosp compared with PBO.
⚡️This trial followed pts with T2D, ASCVD, & eGFR ≥30.
⭐️A long-term follow-up analysis of EMPA-REG OUTCOME, released at the #AHA20 Scientific Sessions, found that empagliflozin decreased burden of any CV outcome in pts with T2D & ASCVD.
⭐️Dapagliflozin could be a good addition.
⭐️Dapagliflozin showed positive results in a composite endpoint of HF pts in the DAPA-HF trial.
⚡️Like Ro, pts in this trial had HFrEF & high NT-proBNP levels while ~40% also had T2D & CKD.
⭐️A follow-up to DAPA-HF presented at the #AHA20 Scientific Sessions showed substantial dapagliflozin benefits w/ HFrEF even in pts with long-term HF (>5 years).
⭐️Canagliflozin could be a good addition for this pt.
⚡️The CREDENCE trial with canagliflozin was designed for pts like Ro b/c all had T2D & CKD & ~15% also had HF.
⭐️Compared with PBO, canagliflozin reduced ESRD, death from renal causes, & death from CVD, as well as HF hosp.
⚡️You prescribe canagliflozin 100 mg QD after making sure her eGFR was high enough.
🚨In CREDENCE, baseline eGFR was ~56 mL/min/1.73m2. Canagliflozin is contraindicated in pts with eGFR <30 mL/min/1.73m2.
👩🦳Ro did well for a while & showed some improvement on EF, to 40%.
🚨However, after 2 yrs, she has recurrent ADHF & can no longer accomplish ADLs.
⚡️EF is persistent between 38%–40%.
🧐What can be done to prevent another hosp & improve Ro's QOL❓
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