Abstract | December 16, 2022

Case of Initiating Dapagliflozin in a Patient with Ventricular Assistance Device

Presenting Author: Riaz Mahmood, DO, MS, Chief Resident Internal Medicine PGY-4, Department of Internal Medicine, Graduate Medical Education, Northeast Georgia Medical Center, Gainesville, Georgia

Coauthors: Moaz Ahmad, MD, Hospitalist, Poplar Bluff Regional Medical Center, Poplar Bluff, MO, Hua Ling, PharmD, Associate Professor, Philadelphia College of Osteopathic Medicine - Georgia Campus, Suwanee, GA, Ugochukwu Egolum, MD, Program Director, Cardiovascular Disease Fellowship, Georgia Heart Institute, Gainesville, GA

Learning Objectives

  1. Discuss the use of SGLT2 inhibitors in patients with ventricular assistance devices

Introduction: Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) were found to reduce the composite endpoint of cardiovascular death or worsening heart failure in the EMPEROR-Reduced trial and DAPA-HF trial. However, patients with ventricular assistance devices (VAD) were excluded from the aforementioned trials, therefore, the role of SGLT2i in the cohort of patients with VAD is unclear.

 

Case Presentation: A 67-year-old male with NYHA Class II ACC/AHA stage D heart failure with reduced ejection fraction (HFrEF), secondary to nonischemic cardiomyopathy, presented for elective admission for plans for VAD implantation. He was status post HeartMate III VAD implantation as destination therapy. Dapagliflozin 10 mg was initiated on the day of discharge, along with other guideline-directed medical therapy. During approximately three months after initiation, dapagliflozin was well tolerated without any negative change in the disease status. His vital signs remained stable, and lab values were significant for improvement in NT-proBNP with stable creatinine and sodium.

 

Final/Working Diagnosis: Reduced ejection heart failure and post HeartMate III VAD implantation

 

Management/Outcome: To date, no clinical data about the role of SGLT2i in patients with VAD has been reported. Nevertheless, dapagliflozin was initiated for this patient given the substantial benefits of SGLT2i therapy reported.

In this case report, dapagliflozin was initiated after the implantation of VAD without any adverse events noticed. Considering the substantial benefits of SGLT2i therapy in patients with HFrEF, it is imperative to evaluate the efficacy and safety of SGLT2i therapy in patients with VAD.

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  2. McMurray JJV, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911303. Epub 2019 Sep 19. PMID: 31535829.
  3. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 May 3;145(18):e895-e1032. doi: 10.1161/CIR.0000000000001063. Epub 2022 Apr 1. Erratum in: Circulation. 2022 May 3;145(18):e1033. PMID: 35363499.

 

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