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Recommendation Table 1 — Recommendation for the treatment of patients with symptomatic heart failure with mildly reduced ejection fraction

Recommendation Classa Levelb

An SGLT2 inhibitor (dapagliflozin or empagliflozin) is recommended in patients with HFmrEF to reduce the risk of HF hospitalization or CV death.c 6,8 I A © ESC 2023

CV, cardiovascular; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; SGLT2, sodium–glucose co-transporter 2. aClass of recommendation. bLevel of evidence. cThis recommendation is based on the reduction of the primary composite endpoint used in the EMPEROR-Preserved and DELIVER trials and in a meta-analysis. However, it should be noted that there was a significant reduction only in HF hospitalizations and no reduction in CV death. Recommendation Table 2 — Recommendation for the treatment of patients with symptomatic heart failure with preserved ejection fraction

Recommendation Classa Levelb

An SGLT2 inhibitor (dapagliflozin or empagliflozin) is recommended in patients with HFpEF to reduce the risk of HF hospitalization or CV death.c 6,8 I A © ESC 2023

CV, cardiovascular; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; SGLT2, sodium–glucose co-transporter 2. aClass of recommendation. bLevel of evidence. cThis recommendation is based on the reduction of the primary composite endpoint used in the EMPEROR-Preserved and DELIVER trials and in a meta-analysis. However, it should be noted that there was a significant reduction only in HF hospitalizations and no reduction in CV death.

Management of patients with HFpEF

Diuretics for fluid retention

(Class I) Treatment for aetiology, CV and non-CV comorbodities

(Class I)

Dapagliflozin/ Empagliflozin

(Class I)

Figure 2 Management of patients with heart failure with preserved ejection fraction. CV, cardiovascular; HFpEF, heart failure with preserved ejection fraction.

Management of patients with HFmrEF

Diuretics for fluid retention

(Class I) Dapagliflozin/

Empagliflozin

(Class I) ACEI/ARNI/ARB

(Class IIb) MRA (Class IIb) Beta-blocker

(Class IIb)

Figure 1 Management of patients with heart failure with mildly reduced ejection fraction. ACE-I, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; HFmrEF, heart failure with mildly reduced ejection fraction; MRA, mineralocorticoid receptor antagonist.

ESC Guidelines                                                                                                                                                                                          3633

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