Heart Failure Guidelines Update: What the ESC Got Right

This transcript has been edited for clarity.

Hello. I'm Ileana Piña. I'm a professor of medicine at Thomas Jefferson University Hospital. This is my usual blog, except I am here from the absolutely beautiful city of Amsterdam, where the European Society of Cardiology (ESC) 2023 meeting has been going on.

SGLT2 Inhibitors for HFpEF and HFrEF

I'm going to review very briefly the 2023 focused update to the ESC heart failure guidelines. Theresa McDonagh was the first author of this and of the previous ESC or European guidelines. These are a little bit different than the American guidelines, which were presented in 2022. We know that we need an update. The Europeans have gotten ahead of us, and now we have the European update, which I find incredibly well written and it really highlights the areas that I think the takeaways are for the clinicians.

First, we have been seeing now for several years — since 2018 — the benefits of the sodium-glucose cotransporter 2 (SGLT2) inhibitors. Every time we lift the veil on something, there they are in a positive light. We have learned about heart failure with reduced ejection fraction (HFrEF) for both empagliflozin and dapagliflozinThere are very similar results. One population may be enriched with a little of this and a little of that, but the basic messages are the same. In HFrEF, both of these drugs improve outcomes and it happens quickly. You don't have to wait 1 or 2 years to see this. Within months, and actually within days, you start to see the curves split apart statistically.