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Obesity-related HFpEF — EECC MCQ

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EasyHeart FailureObesity-related HFpEFEECC

A 66-year-old woman with HFpEF (LVEF 58%), obesity (BMI 38 kg/m²), type 2 diabetes, and obstructive sleep apnoea presents with NYHA class III symptoms despite diuretic therapy. Which of the following has the strongest evidence for symptom and outcome improvement in this patient?

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Correct answer: E — Empagliflozin

SGLT2 inhibitors (empagliflozin and dapagliflozin) are the only drug class with Class I (LOE A) recommendation for HFpEF in the 2023 ESC HF Focused Update, based on the EMPEROR-Preserved and DELIVER trials demonstrating reduction in the composite of cardiovascular death or HF hospitalisation across the entire EF spectrum. Spironolactone showed borderline results in TOPCAT. Sacubitril/valsartan showed benefit in PARAGON-HF primarily in lower EF ranges. CPAP for OSA has not demonstrated cardiovascular outcome benefit. Semaglutide (STEP-HFpEF) improved symptoms and weight but is not yet in ESC HF guidelines.

Reference: ESC (2023): Focused Update on Heart Failure