An echocardiogram is recommended to confirm the diagnosis and classify heart failure. 1 Clinical diagnosis is made following a patient history, physical examination and investigations. However, there is limited evidence to guide which option to select first and when to employ both options.Īn estimated 480,000 people in Australia have heart failure. The clinical place of dapagliflozin in the treatment of HFrEF is for people who have persistent LVEF ≤ 40% despite receiving optimal standard treatment that may or may not include an MRA.Ĭhanging the ACE inhibitor (or ARB) to an ARNI is another PBS-listed option for these patients.SGLT2 inhibitors are included as standard treatment for HFrEF with LVEF ≤ 40% in combination with an ACE inhibitor (or ARB or ARNI), heart failure beta blocker and MRA. Updated international guidance recommends an expanded role for dapagliflozin and other SGLT2 inhibitors for HFrEF with LVEF ≤ 40%.The guidelines only recommend dapagliflozin and other SGLT2 inhibitors to reduce the risk of heart failure-related hospitalisation for people with CVD and type 2 diabetes with insufficient glycaemic control despite receiving metformin. Current Australian guidelines define HFrEF as LVEF The treatment must be an add-on therapy to optimal standard treatment, which must include, unless contraindicated or cannot be tolerated, a beta blocker and ACE inhibitor or ARB or ARNI. The new indication is symptomatic (NYHA class II–IV) heart failure and LVEF ≤ 40%.
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On 1 January 2022, a new indication and clinical criteria were added to the Authority Required (Streamlined) PBS listing for dapagliflozin (Forxiga).