In which scenario would the addition of an SGLT2 inhibitor be indicated in heart failure management?

The addition of an SGLT2 inhibitor is particularly indicated in heart failure management for patients with heart failure with reduced ejection fraction (HFrEF). This class of medications has been shown to provide significant cardiovascular and renal benefits in patients with HFrEF, including reducing the risk of hospitalization due to heart failure and improving overall heart failure outcomes.

SGLT2 inhibitors work by promoting diuresis and reducing the workload on the heart while also having favorable effects on glycemic control and weight management. These benefits are crucial in the context of HFrEF, where fluid overload and metabolic derangements often exacerbate the condition.

In contrast, the other scenarios do not specifically align with the primary indications for SGLT2 inhibitors. For example, while heart failure with preserved ejection fraction (HFpEF) can sometimes involve similar therapeutic approaches, current guidelines primarily support the use of SGLT2 inhibitors in HFrEF. Additionally, mere blood pressure control or improving patient compliance does not directly justify the initiation of an SGLT2 inhibitor in the context of heart failure management. Hence, the focus on patients with reduced ejection fraction highlights the targeted use of these agents in improving clinical outcomes for this specific heart failure population.