Heart Failure SGLT2i Master Class : Pre-test

1.

A 72-year-old woman with nonischemic cardiomyopathy (LVEF 25%) and long-standing type 2 diabetes mellitus presents for follow-up 6 weeks after hospitalization for acute decompensated heart failure. Her current medications include sacubitril/valsartan 49/51 mg twice daily, carvedilol 25 mg twice daily, dapagliflozin 10 mg daily, furosemide 40 mg daily, and metformin 1000 mg twice daily. She reports mild exertional dyspnea but no orthopnea or PND. Her BP is 96/62 mm Hg, HR is 68 beats/min, eGFR is 40 mL/min/1.73 m², and serum potassium is 4.7 mEq/L. NT-proBNP remains elevated at 1600 pg/mL. Which of the following represents the most significant gap in her current heart failure management according to GDMT?

A. Up-titrate sacubitril/valsartan to target despite borderline BP
B. Initiate a mineralocorticoid receptor antagonist with careful monitoring of potassium and renal function
C. Replace dapagliflozin with an alternative SGLT2 inhibitor due to persistent NT-proBNP elevation
D. Refer for device-based therapy given ongoing symptoms despite multidrug therapy

2.

Which of the following statements most accurately reflects the evidence and mechanism of the efficacy, safety, and cardiovascular benefits of early and sustained SGLT2 inhibitor therapy in patients with heart failure?

A. The cardiovascular benefits of SGLT2 inhibitors are primarily due to improved glycemic control and are attenuated in patients without diabetes
B. The decline in eGFR after SGLT2 inhibitor initiation reflects renal injury, limiting their long-term use in patients with stage 4 kidney disease
C. The benefits of SGLT2 inhibitors in heart failure emerge after several weeks of therapy and depend on achieving maximum tolerated doses of other GDMT agents first
D. SGLT2 inhibitors confer early and sustained reductions in heart failure hospitalization and cardiovascular death, independent of renal function

3.

A 74-year-old woman with heart failure with HFpEF (LVEF 58%) and stage 3b chronic kidney disease (eGFR 32 mL/min/1.73 m²) presents with fatigue and dyspnea on exertion (NYHA II). She is receiving losartan, furosemide, and amlodipine. Her BP is 132/73 mm Hg, A1C is 6.4%, and she does not have diabetes. Which strategy best aligns with current evidence and practical integration principles for SGLT2 inhibitor use in this patient?

A. Initiate an SGLT2 inhibitor once eGFR improves >45 mL/min/1.73 m², since evidence is limited in patients with eGFR <45 mL/min/1.73 m²
B. Prioritize up-titration of antihypertensive therapy before introducing an SGLT2 inhibitor due to lack of evidence of mortality reduction in patients with HFpEF
C. Initiate an SGLT2 inhibitor while monitoring for volume depletion
D. Prioritize up-titration of antihypertensive therapy before introducing an SGLT2 inhibitor to minimize the risk of symptomatic hypertension

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Arm-in-Arm With Heart Failure Experts: A Master Class in Optimizing Heart Failure Treatment With SGLT2 Inhibitors

Midge Bowers, DNP, FNP-BC, FAANP, FAAN, FACC

Javed Butler, MD, MPH, MBA

Ty J. Gluckman, MD, MHA, FACC, FAHA, FASPC

Stephen J. Greene, MD

Pretest

Please answer the questions below.

1.

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