Emerging treatments
Sotagliflozin
Sotagliflozin is an inhibitor of both sodium-glucose cotransporter (SGLT)-1 and SGLT-2. The US Food and Drug Administration has approved sotagliflozin to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure across the full range of left ventricular ejection fraction (including preserved ejection fraction and reduced ejection fraction), or adults with type 2 diabetes, chronic kidney disease, and other cardiovascular risk factors.
Praliciguat
Praliciguat is an oral soluble guanylate cyclase stimulator. In 2018 it received fast track designation from the Food and Drug Administration (FDA) for the treatment of HFpEF. Since then, the CAPACITY HFpEF randomized controlled trial found that, compared with placebo, praliciguat did not significantly improve peak rate of oxygen consumption from baseline to week 12.[141]
Remote monitoring
Implantable hemodynamic monitoring has been associated with a reduction in hospitalizations for HF. In the CHAMPION trial, the rate of HF-related hospitalizations at 6 months in patients with HFpEF whose care was guided by a pulmonary artery pressure monitoring device (CardioMEMS) was 46% lower than the control group.[142] However, there were methodologic concerns about this trial, including being nonblinded. In the GUIDE-HF trial, which was blinded, a composite primary endpoint of mortality and total heart failure events was not reduced by use of hemodynamic-guided care with CardioMEMS.[143] The American College of Cardiology suggests that implantable hemodynamic monitoring may be most useful in patients with HFpEF who: experience one or more hospitalizations for HF and continue to experience NYHA functional class III symptoms despite optimal guideline-directed medical therapy; experience significant lability in volume status despite close ambulatory monitoring; have cardiorenal syndrome; or have comorbidities, such as obesity or chronic lung disease, for which differentiation of HF from other causes of dyspnea is difficult.[2]
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