Flozins in heart failure – a new reimbursement indication

Abstract


 
 
 Sodium-glucose cotransporter-2 inhibitors, called flozins, are a relatively new group of drugs that quickly have gained recognition among diabetologists, cardiologists, and nephrologists. The mechanism of their action is based on inhibition of the reabsorption of glucose inside the proximal tubule of nephron, which results in lowering a blood glucose level. In addition, flozins reduce blood pressure, cause weight loss, and reduce the risk of death from cardiovascular causes. Until recently, the potential of flozins was used only to treat patients with type 2 diabetes. The clinical trials published several years ago on three representatives of this group of drugs: dapagliflozin, empagliflozin, and canagliflozin, showed that their use in patients with type 2 diabetes and cardiovascular disease reduces the risk of hospitalization and death from cardiovascular causes. These trials prompted scientists to extend research on the effectiveness of flozins in lowering the risk of complications of heart failure and cardiovascular diseases. Subsequent studies showed that regardless of whether a patient with cardiovascular disease has diabetes, the effectiveness of empagliflozin and dapagliflozin is comparable in reducing hospitalizations and cardiovascular deaths. These discoveries resulted in flozins appearing in the European Society of Cardiology guidelines as one of the first-line drugs in heart failure with reduced ejection fraction. In Poland, empagliflozin, and dapagliflozin obtained a new reimbursement indication on May 1, 2022 – chronic heart failure with reduced ejection fraction in patients meeting specific criteria. It’s a significant step in treating heart failure, which is still a substantial cause of death and hospitalizations in Poland, especially among the aging population. The aim of this review is to show the path that flozins have gone from being an antidiabetic drug to being the first-line drug in the treatment of heart failure and to draw the attention of readers to the new reimbursement indication of flozins in Poland.