Acute Heart Failure in Heart Failure with Preserved Ejection Fraction: A State-of-the-art Review from an International Expert Group.

122 The DAPA-ACT-HF-TIMI-68 and DICTATE-AHF trials, in which dapagliflozin was initiated during hospitalisation, found signals towards benefit, but the primary endpoints did not reach statistical significance. 123 , 124 Therefore, SGLT2Is are recommended by the European Society of Cardiology HF guidelines to be started as soon as the patient is haemodynamically stable and able to tolerate oral therapy. 125 In the FINEARTS-HF trial, finerenone, a non-steroidal MRA, reduced the composite endpoint of cardiovascular death and HF events in patients with EF >40%. 126 The absolute risk reduction was modest, but patients enrolled fewer than 7 days after discharge derived the greatest benefit.

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