Approach to pharmacologic therapy for heart failure with preserved ejection fraction

In patients with obesity, it is reasonable to begin therapy with either an SGLT2 inhibitor or GLP-1 receptor agonist. Factors that may influence the choice of initial therapy include weight loss effects of GLP-1 receptor agonists, risk of mycotic infection with SGLT2 inhibitors, and cost. We suggest therapy with both agents, but monotherapy may be reasonable in scenarios that include a favorable response to a single agent or high cost of dual therapy.

BMI: body mass index; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; GLP-1: glucagon-like peptide 1; HFpEF: heart failure with preserved ejection fraction; MRA: mineralocorticoid receptor antagonist; SGLT2: sodium-glucose co-transporter 2.

* Volume overload is typically treated with a loop diuretic. In patients with mild volume overload who are likely to benefit from SGLT2 inhibitor therapy, the diuretic effect of an SGLT2 inhibitor agent may adequately treat volume overload. However, use of an SGLT2 inhibitor without a loop diuretic requires follow-up to ensure adequate diuresis.

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Approach to pharmacologic therapy for heart failure with preserved ejection fraction

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