New Medications Improve Life for People with Heart Failure

More than 6 million people in the United States have heart failure, and many of them are feeling better, spending less time in the hospital, and living longer with the help of new medications called SGLT2 inhibitors.

“We are thrilled about this new group of medications that, while initially used for the treatment of type 2 diabetes, when studied in coronary patients, had a surprising benefit — they decreased heart failure hospitalizations and improved survival — not just in diabetic patients, but also in nondiabetic patients,” says Dr. Renee Sangrigoli, a cardiologist and heart failure expert with Doylestown Health.

First, the Food and Drug Administration approved the SGLT2 inhibitor Farxiga® (dapagliflozin), followed by Jardiance® (empagliflozin), to reduce the risk of death and hospitalization in people who have heart failure with reduced ejection fraction. Then, in February 2022, the FDA extended the use of Jardiance to people who have heart failure with normal ejection fraction.

“We were involved with the study and it was exciting to see the results,” says Dr. Sangrigoli, an investigator for the EMPEROR-Preserved® phase III clinical trial. “Before this, we had no medication for people with heart failure with normal (preserved) heart function, which is 50% of our patients with heart failure.”

Causes and Symptoms

Heart failure happens when your heart is weak or stiff and has trouble pumping blood and oxygen to the rest of your body. You may experience heart failure after a heart attack, coronary artery disease, high blood pressure, heart valve disease, due to inherited cardiac disorders, and other risk factors.

When your heart can no longer meet your body’s needs, fluid may back up into the lungs, legs, and other areas, forcing your heart to work even harder. Symptoms of heart failure include:

• Shortness of breath
• Swelling in the legs, feet, or abdomen
• Needing to sleep propped on pillows
• Fatigue
• Persistent cough or wheezing
• Rapid weight gain from fluid retention

If you experience heart failure symptoms, call your doctor. “It is important at that time to determine both the type of heart failure and the cause of heart failure in patients. We then determine appropriate testing needed including echocardiograms, labs, and even tests to exclude artery blockages,” says Dr. Sangrigoli.

Types of Heart Failure

“There are different types of heart failure based on a measurement of your heart’s pumping ability, called ejection fraction,” explains Dr. Sangrigoli. This tells us how effectively your ventricles (chambers) are pushing the blood with each heartbeat.

• Heart failure with preserved left ventricular function means your left ventricle is pumping sufficiently but not relaxing well.
• Heart failure with reduced left ventricular function is when your ventricle is not pumping enough blood.
• A newer term, Heart failure with mid-range ejection fraction is for measurements that fall between preserved and reduced function.

Treating Heart Failure

While there is no cure, we have treatments to help relieve symptoms and stop or slow the progress of your condition. “Lifestyle changes, a heart-healthy diet, medications, implantable devices and other surgical procedures can improve quality of life and get you back to doing many of the activities that you love,” says Dr. Sangrigoli.

“Every person with heart failure and normal ejection fraction, unless there are contraindications, should discuss with their physician and consider Jardiance (empagliflozin),” says Dr. Sangrigoli, who served as an investigator in the Emperor clinical trials that demonstrated the medication’s effectiveness in treating heart failure. “In addition, the newest Heart Failure Guidelines from the American College of Cardiology/American Heart Association were just released and SGLT2 inhibitors Farxiga (dapagliflozin) and Jardiance (empagliflozin) were listed as cornerstone treatments for heart failure with reduced ejection fraction,” says Dr. Sangrigoli. “Many of my patients, I would say 70% or more, are saying they notice a difference in how they feel within about two weeks of starting SGLT2 inhibitors, which is amazing. With most heart failure medications, we wait weeks to months to see the benefit.”