SGLT2i, ARNi and Diuretic Use in Patients with Heart Failure Among the Preserved and Reduced Ejection Fraction: A Retrospective Observational Study

Background: The treatment regimen of SGLT2i, ARNi, and diuretics have been proven to be very useful in the management of heart failure. This study aimed to assess the change in diuretic and sacubitril/valsartan doses after the initiation of SGLT2i and the combined treatment’s influences on the patient’s clinical and physical parameters. Methods This retrospective study was conducted in HFrEF/HFpEF patients initiated on SGLT2i, ARNi and diuretics and stratified by furosemide-equivalent doses (FEQ) (<40mg vs. ≥40mg). The ICD-10 code I50.9 was used to retrieve the data. A specialised data collection form was used to collect data on diuretic and ARNi dose changes, NYHA class shifts post-SGLT2i initiation, demographics, and echocardiographic/clinical parameter differences. Statistical analysis was performed using the IBM SPSS statistical software (V.29.0; SPSS Inc, Chicago, Illinois, USA). Results: Among the 103 patients, diuretic dose reductions were observed in 7.1% of patients receiving FEQ dose<40mg and 34.8% who received FEQ dose≥40mg. ARNi dose increases were observed in 21.4% and 20.2% in the of patients receiving FEQ dose<40mg and FEQ dose≥40mg, respectively. There was a significant change in NYHA-FC from Median (IQR)of [2(2,3)] at baseline to [2(2,2)] at the next follow-up visit in patients receiving FEQ dose≥40mg. Similarly, there was an improvement of the Left Ventricular Ejection fraction [29.00(25.00,30.00)] to [30.00(25.00,35.00)] with p<0.001 in patients receiving FEQ dose≥40mg. Conclusion: FEQ doses ≥40mg were found to be associated with significant clinical improvements, while the increase in ARNi doses supported the generally accepted statement that up-titration led to better clinical outcomes.