Most HF patients do not undergo loop diuretic dose reduction after SGLT2i initiation

Majority of the patients with heart failure (HF) who have initiated treatment with sodium-glucose cotransporter 2 inhibitor (SGLT2i) show no change in loop diuretic dose, reports a study.

In patients with a dose reduction in loop diuretic, most have occurred within 6 months following SGLT2i initiation instead of empirically at time of initiation.

A team of investigators performed this retrospective evaluation to examine the frequency and degree of adjustments in loop diuretic doses after SGLT2i initiation in patients seen in the UCHealth system with a diagnosis of HF who were prescribed a loop diuretic before starting SGLT2i therapy.

Changes in loop diuretic dose were described at the time of SGLT2i initiation, at 6 months after initiation, and at 1 year following initiation. The researchers also described de-escalation of maintenance medications that can contribute to hypotension at these time points. Finally, descriptive statistics were applied to assess the data.

One hundred HF patients were included in the study. Loop diuretic dose was empirically reduced in 2.0 percent of patients upon SGLT2i initiation, while 8.0 percent of patients had loop diuretic dose reduction within the first 6 months of starting an SGLT2i. Moreover, 14.0 percent of patients had loop diuretic dose reduction from baseline to 12 months following SGLT2i initiation.

“SGLT2is have demonstrated cardiovascular benefits in patients with HF, many of which take loop diuretics,” the investigators said.

“There are no evidence-based recommendations identifying which patients may require loop diuretic dose decreases or how to adjust loop diuretic doses when SGLT2is are initiated,” they added.