TY - THES ID - 135020737 TI - The role of sodium-glucose cotransporter-2 inhibitors in heart failure management and the challenge of clinical outcome endpoints in heart failure trials AU - Ji, Luxi AU - De Geest, Bart AU - KU Leuven. Faculteit Geneeskunde. Opleiding Master in de geneeskunde (Leuven) PY - 2023 PB - Leuven KU Leuven. Faculteit Geneeskunde DB - UniCat UR - https://www.unicat.be/uniCat?func=search&query=sysid:135020737 AB - Heart failure is the cardiovascular epidemic of the 21st century. The ejection fraction has a bimodal distribution among patients with incident heart failure. A distinction is made between heart failure with reduced ejection fraction (HFrEF) (ejection fraction ≤40%), heart failure with mid-range or mildly reduced ejection fraction (40.1%-49.9%) (HFmrEF), and heart failure with preserved ejection (HFpEF) (ejection fraction ≥ 50%). The introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors in heart failure management has been regarded by many as a significant advance, in particular in the treatment of HFpEF. The primary outcome measure in definitive phase III clinical trials should be a clinical event relevant to the patient or an endpoint that measures directly how a patient feels, functions or survives, where function refers to patients’ ability to perform activities in their daily lives. The application of this definition in the field of heart failure is complex. The major goals of heart failure treatment have been categorized as: (1) reduction in (cardiovascular) mortality, (2) prevention of recurrent hospitalizations due to worsening heart failure, and (3) improvement in clinical status, functional capacity, and quality of life. The use of the composite primary endpoint of cardiovascular death and hospitalization for heart failure in SGLT2 inhibitor HFpEF trials was not justified since the effect of the intervention on both components was clearly distinct. Moreover, the lack of convincing and clinically meaningful effects of SGLT2 inhibitors on metrics of heart failure-related health status indicates that the effect of this class of drugs in HFpEF patients is essentially restricted to an effect on hospitalization for heart failure. In conclusion, SGLT2 inhibitors do not represent a major breakthrough in the management of HFpEF. ER -