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SGLT-2 Inhibitors on Top of Current Pharmacological Treatments for Heart Failure: A Comparative Review on Outcomes and Cost Effectiveness

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Abstract

Heart failure (HF) represents a major global health and economic burden with still unacceptably high morbidity and mortality rates. In recent decades, novel therapeutic opportunities with a significant impact on HF outcomes have been introduced in addition to angiotensin-converting enzyme (ACE) inhibitors, β-blockers, and mineralocorticoid receptor antagonists. These include drugs such as ivabradine, sacubitril–valsartan, and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. The availability of an extremely large pharmacological armamentarium to face this chronic global disease highlights the importance of assessing cost effectiveness to promote sustainable healthcare. In light of the recent approval of SGLT-2 inhibitors for the treatment of HF with reduced ejection fraction, including in individuals without type 2 diabetes mellitus, the aim of this review was to provide an updated comparative evaluation of the efficacy and cost effectiveness of different pharmacological treatments for the prevention (stage A) and treatment of asymptomatic (stage B) and symptomatic (stages C–D) left ventricular dysfunction.

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Authors and Affiliations

  1. Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy

    Ilaria Cavallari, Annunziata Nusca & Francesco Grigioni

  2. Department of Experimental Medicine, La Sapienza University, Rome, Italy

    Ernesto Maddaloni & Raffaella Buzzetti

  3. Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy

    Dario Tuccinardi & Paolo Pozzilli

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  1. Ilaria Cavallari
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  2. Ernesto Maddaloni
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Correspondence to Ilaria Cavallari.

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The authors did not receive any funding for this article.

Conflict of interest

IC received honoraria from BMS-Pfizer and Boehringer Ingelheim. EM has received grants from scientific societies supported by Lilly and AstraZeneca and honoraria or consulting fees from Merck-Serono, Pikdare, AstraZeneca, and Abbott. RB has received honoraria or consulting fees from Sanofi, Eli Lilly, Abbott, and AstraZeneca. PP has received research support from Eli Lilly and Company and serves on the speaker bureau for Sanofi‐Aventis. AN, DT, and FG have no conflicts of interests related to this manuscript.

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Dr. Cavallari and Prof. Grigioni discussed the content of the article. All authors contributed to the literature search. Drs Cavallari and Maddaloni and Prof. Grigioni drafted the first version of the manuscript. Dr. Cavallari drafted the tables and figures. Drs Nusca and Tuccinardi and Profs Buzzetti and Pozzilli critically revised the manuscript.

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Cavallari, I., Maddaloni, E., Nusca, A. et al. SGLT-2 Inhibitors on Top of Current Pharmacological Treatments for Heart Failure: A Comparative Review on Outcomes and Cost Effectiveness. Am J Cardiovasc Drugs 22, 263–270 (2022). https://doi.org/10.1007/s40256-021-00508-3

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