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SGLT2i plus MRAs for Heart Failure: A Sweet or Sour Combination?

We now have “diabetes medications” to treat heart failure with reduced ejection practice (HFrEF). Many clinicians have not yet used a sodium-glucose transporter 2 inhibitor (SGLT2i) for the treatment of HF and are (rightfully) concerned about potential drug-drug interactions, particularly when using an SGTL2i with a mineralocorticoid (MRA). A recent secondary analysis using data from the EMPEROR-Reduced study may provide some reassurance.

Guest Authors:  B. Blake Miller, PharmD, BCPS and Jennifer Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

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Raised From The Grave: A Second Life for Sotagliflozin?

The prevalence of heart failure in patients with diabetes is four times higher than in the general population.  Likewise, chronic kidney disease (CKD) and diabetes are common morbidities. As new drug classes emerge in the management of diabetes and heart failure and CKD, it is important to thoroughly evaluate available literature and identify opportunities to reduce complications and costs. Sotagliflozin is a first-in-class dual SGLT-1 and 2 inhibitor approved in Europe.  Does it improve outcomes in patients with heart failure or CKD?

Guest Authors:  Maren Richards Brinton, PharmD and Jonathan C. Hughes, PharmD, BCPS, BCACP

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Is Dapagliflozin aDAPtAble to Treating HFrEF in Patients Without Diabetes?

Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality. Current guidelines recommend a renin-angiotensin inhibitor, beta-blocker, and aldosterone antagonist to reduce morbidity and mortality in these patients. Despite the use of multiple drug classes, 5-year mortality rates hover near 50% in patients with heart failure (HF). Despite the numerous medications available, mortality and the risk of HF hospitalizations remains high. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) have been shown to reduce HF hospitalizations in patients with diabetes. Could this medication class be useful for HF treatment even in patients without diabetes?

Guest Authors:  John Andraos, PharmD; Alexa Zeiger, PharmD; and Michael S. Kelly, PharmD, BCACP

Music by Good Talk

If Your Heart’s Not into It, Do You Really Need to Take Your Meds?

Dilated cardiomyopathy is the leading cause of sudden cardiac death and heart failure (HF) and the chief indication for cardiac transplantation. However, approximately 40% of patients see a significant improvement in left ventricular ejection fraction and reduction in the left ventricle size over time with pharmacologic treatment. As deprescribing becomes an increasingly important part of our clinical practice, we need more data about how deprescribing impacts outcomes, particularly in chronic diseases such as heart failure.  The recently published TRED-HF is attempted to address this important question: Is the burden of lifelong therapy with medications necessary or worth it in patients with "recovered" dilated cardiomyopathy?

Guest Author:  Jennifer Pruskowski, PharmD, BCPS, BCGP, CPE

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Helpful, Harmful, or Futile — Antidepressant Use in Patients with Heart Failure

About 5 million Americans are currently living with heart failure (HF) and an astounding 24-42% also suffer from depression.  One meta-analysis found a greater than 2-fold risk of death in patients with HF and comorbid depression.  Depressed patients with HF are more likely to be hospitalized, seek care from emergency rooms, and rack up big bills.  Not surprisingly, patients with HF and depression have a much lower quality of life when compared to HF patients without depression.  Clearly, this is BIG problem.  But can we do anything about it?

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Does Coenzyme Q10 Have the ENERGY to Change Heart Failure Therapy?

Could a nutritional supplement be the “magic bullet” in heart failure therapy?  Coenzyme Q10 (CoQ10), or ubiquinone, is an electron carrier in mitochondria and plays a key role in ATP synthesis. It is also thought to have antioxidant effects and may stabilize LDL molecules. All of which would, theoretically, help the failing heart.

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