Heart Failure SGLT2i Master Class : Pre-test

1.

Your patient is a 68-yr-old man with hypertension, CKD, and a recent diagnosis of HFrEF (EF 30%) made 2 wk ago after an outpatient echocardiogram. He presents to the ED with worsening dyspnea. His vital signs are within the normal range. His oxygen saturation is normal on 2L oxygen via nasal cannula. He has an elevated JVP and 2+ lower extremity edema. He responds well to intravenous diuretic therapy and is now euvolemic, eating well, and ambulating on the ward. His outpatient ACE inhibitor was switched to an ARNI, and he was started on a low-dose β-blocker. When would you consider initiation of an SGLT2 inhibitor?

A. During follow-up with his PCP in the next 2 wk
B. During his first follow-up with his cardiologist in the next mo
C. Before hospital discharge, once the patient is clinically stable
D. At the time of discharge so prescriptions can be discussed during discharge planning

2.

Which of the following best summarizes the evidence from major randomized clinical trials regarding the use of SGLT2 inhibitors in patients with heart failure, regardless of ejection fraction?

A. They reduce cardiovascular death and heart failure hospitalization across a broad spectrum of ejection fractions, with early benefits observed within weeks of initiation
B. They improve glycemic control and reduce hospitalization risk in patients with diabetes but show minimal benefit in patients without diabetes
C. Long-term use of SGLT2 inhibitors is associated with a high incidence of hypotension and risk of dehydration, limiting their use in patients with HFrEF
D. There is limited evidence to support SGLT2 inhibitor use in HFpEF, with benefits primarily confined to advanced HFrEF

3.

A 74-yr-old woman with a history of hypertension and obesity presents with increasing fatigue and exertional dyspnea over the past 3 mo. She has CKD with an eGFR of 48 mL/min/1.73 m². She does not have diabetes mellitus. She is on amlodipine and hydrochlorothiazide. Her echocardiogram demonstrates an LVEF of 56%, mild left atrial enlargement, and moderate diastolic dysfunction. Her NT-proBNP level is elevated. She is felt to have NYHA class II functional status. Which of the following is the most appropriate approach as it relates to an SGLT2 inhibitor?

A. Defer starting an SGLT2 inhibitor due to the absence of type 2 diabetes and preserved left ventricular ejection fraction
B. Avoid an SGLT2 inhibitor unless she develops NYHA class III or IV functional status or she develops left ventricular systolic dysfunction
C. Switch her hydrochlorothiazide to furosemide before considering an SGLT2 inhibitor to minimize overlapping diuretic effects
D. Recommend an SGLT2 inhibitor now to reduce the risk of hospitalization for HF and to improve her quality of life, while monitoring her renal function periodically

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Arm-in-Arm With Heart Failure Experts: A Master Class in Optimizing Heart Failure Treatment With SGLT2 Inhibitors

Midge Bowers, DNP, FNP-BC, FAANP, FAAN, FACC

Javed Butler, MD, MPH, MBA

Ty J. Gluckman, MD, MHA, FACC, FAHA, FASPC

Stephen J. Greene, MD

Pretest

Please answer the questions below.

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