Dapagliflozin in heart failure

Dapagliflozin (Forxiga) has been introduced as an option for treating symptomatic heart failure with preserved or mildly reduced ejection fraction following a NICE technology appraisal in June. Prior to this, standard care was loop diuretics (along with managing any other conditions the patient may have) but this approach only managed symptoms.

The addition of dapagliflozin along with loop diuretics has been shown to reduce both first hospitalisation rates and the combined risk of dying from cardiovascular causes.

This change, known as the ‘four pillars’ of heart failure treatment, includes beta-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose co-transporter 2 inhibitors. Rather than starting on each medication in sequence and titrating the dose up, the latest clinical evidence shows that all medications should be started at once.