A 58-year-old man with HFrEF (EF 28%) is on maximally tolerated doses of bisoprolol, sacubitril/valsartan, and eplerenone. He remains in NYHA class III. Current SGLT2 inhibitor trials in HFrEF (DAPA-HF, EMPEROR-Reduced) demonstrated that adding dapagliflozin or empagliflozin reduced which primary composite outcome?
- A All-cause mortality and hospitalisation for any reason
- B Worsening HF (hospitalisation for HF or urgent HF visit) or CV death ✓
- C CV death alone
- D Sudden cardiac death and ventricular arrhythmias
Correct answer: B. Worsening HF (hospitalisation for HF or urgent HF visit) or CV death
Explanation
Both DAPA-HF (dapagliflozin) and EMPEROR-Reduced (empagliflozin) trials used the composite primary endpoint of worsening heart failure (first hospitalisation for HF or urgent HF visit requiring IV therapy) or cardiovascular death. Both trials showed significant reductions in this composite outcome (~25% relative risk reduction) in HFrEF patients on standard background therapy including RAS blockers and beta-blockers. SGLT2 inhibitors are now a 'pillar' of HFrEF therapy alongside ACEi/ARNI, beta-blockers, and MRAs (ESC 2021, AHA/ACC 2022).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.