Could SGLT2 inhibitors improve outcomes in patients with heart failure and significant valvular heart disease? Need for action

Delivering valvular intervention for all eligible patients with valvular heart disease (VHD) in a timely manner remains a challenge. Therefore, a high number of patients with heart failure (HF) and VHD receive pharmacotherapy while awaiting intervention or as destination therapy if they are deemed inoperable. The sodium-glucose co-transporter-2 inhibitors (SGLT2i) are recommended with a class I indication for patients with chronic HF throughout the spectrum of left ventricular ejection fraction. However, all randomized trials of SGLT2i in HF patients have consistently excluded patients with significant VHD. Considering the proven benefit of SGLT2i for stable outpatients and acutely hospitalized patients with HF, SGLT2i could potentially be used for patients with HF secondary to significant VHD. This article highlights the unmet need to produce robust clinical evidence for the pharmacological management of patients with HF and significant VHD while summarizing the potential benefit from SGLT2i in the management of these patients.