PYOC Cardiology Profile picture
Dec 7, 2020 14 tweets 4 min read Read on X
➡️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. Image
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. Image
⭐️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. Image
⭐️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. Image
⭐️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). Image
⭐️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. Image
⚡️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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