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HFrEF - SGLT2 Inhibitor Management — EECC MCQ

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EasyHeart FailureHFrEF - SGLT2 Inhibitor ManagementEECC

A 72-year-old woman with HFrEF (LVEF 34%) and type 2 diabetes mellitus is started on dapagliflozin 10 mg once daily. Two weeks later, her eGFR has fallen from 58 to 50 mL/min/1.73 m2. She is asymptomatic with no signs of dehydration. What is the most appropriate action?

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Correct answer: C — Continue dapagliflozin as this initial eGFR dip is expected and typically stabilises

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

An initial dip in eGFR is a well-recognised pharmacological effect of SGLT2 inhibitors related to their tubuloglomerular feedback mechanism. This early reduction typically stabilises within weeks and is associated with long-term renal protection. The drug should only be stopped if the decline is severe (above 30%) or accompanied by clinical deterioration. There is no 5 mg dose of dapagliflozin for HF (C). Switching between SGLT2 inhibitors (D, E) is not indicated for an expected effect.

Reference: ESC (2023): Focused Update of the 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure