New developments in heart failure and sodium-glucose cotransporter 2 inhibitors

Introduction: Heart failure is a current issue due to its growth among the population, especially the elderly, thanks to advances in the effectiveness of its treatment. Heart failure, depending on its etiology, can be systolic or diastolic and depending on the speed of onset of symptoms, acute or chronic. In addition to cardiac anatomical alterations, neurohumoral activation plays a very important role in the clinical picture. For this reason, the therapeutic targets of the most innovative treatments take both factors into account. Objectives: Review of the inclusion and latest developments of iSLGT2 in the medical treatment of heart failure according to LVEF and speed of onset of symptoms. Results and discussion: The group where iSGLT2 are best established is that of reduced LVEF. Both the DAPA-HF (2019) and the EMPEROR-Reduced (2020) studies establish the benefit of dapagliflozin and empagliflozin in reducing hospitalizations and mortality, and therefore the 2021 ESC guide already includes them among its recommendations for reduced LVEF. The most innovative studies are those that go one step further and bet on iSGLT2 in preserved LVEF. Thanks to their results, EMPERORPreserved (2021) and DELIVER (phase III) support their use in this group and their incorporation in the next ESC guidelines is expected. The EMPA-RESPONE-AHF (2019) and the EMPULSE TRIAL (2022) study its use in acute HF with apparent good results.