SCIENTIFIC JOURNAL of the Hungarian Society of Cardiology

The new European Heart Failure Guideline – ESC 2021. The role of SGLT2 inhibition based on evidences

█ Review

DOI: 10.26430/CHUNGARICA.2022.52.2.122

Habon Tamás1, Sepp Róbert2
1Pécsi Tudományegyetem, I. sz. Belgyógyászati Klinika, Kardiológiai Tanszék, Klinikai Farmakológiai Tanszék, Pécs
2Szegedi Tudományegyetem, Belgyógyászati Klinika, Non-Invazív Kardiológiai Részleg, Szeged
Levelezési cím:
Dr. Habon Tamás, Pécsi Tudományegyetem, I. sz. Belgyógyászati Klinika, Kardiológiai Tanszék,
Klinikai Farmakológiai Tanszék, 7624 Pécs, Ifjúság u. 13. E-mail:


The European Society of Cardiology (ESC) guideline on the Diagnosis and Treatment of Acute and Chronic Heart Failure was published on 27 August 2021. Compared to the previous (2016) recommendation, the new guideline contains 41 new and 15 renewed recommendations. The goal of treating patients with heart failure remains to improve clinical status, functional capacity, and quality of life, to prevent hospitalization, and to reduce mortality. There is no significant change in the previously class I A recommended drugs. Neurohormonal antagonists (ACE inhibitors [ACEI], mineralocorticoid receptor antagonists [MRA], and beta-blockers [BB]) have been shown to improve survival in HFrEF and are therefore recommended for use in all HFrEF patients in the absence of contraindications or intolerance. A significant change is that, based on new evidence, inhibitors of sodium glucose cotransporter-2 (SGLT2) are also recommended in first line with an evidence level of I A. Perhaps the most important change in the new recommendation is that instead of hierarchical use of I A-indicated agents, it recommends simultaneous initiation of treatment. The term of HFmrEF (mildly reduced) has been changed in the guideline, and new recommendations have been made for the treatment of this patient group. The expanded indication for the soluble guanylate cyclase receptor stimulator vericiguat and the angiotensin receptor neprilysin inhibitor (ARNI) sacubit­ril/valsartan are also worth mentioning. In addition to a brief description of the treatment of chronic heart failure, this review also highlights the evidence and potential uses of the I A recommendation for SGLT2 inhibitors in more detail.


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