Dr Sim: There is an ongoing trial looking at the use of SGLT2 inhibitors in acute heart failure settings. The result should be out in a couple of years. In acute heart failure setting (like the design in PIONEER–HF trial), after the first 24 to 48 hours when the patient is stabilised in terms of the hemodynamic, blood pressure, is not on any inotrope and is taken off of the intravenous diuretics; importantly the acute kidney injury has been resolved, that’s when the drug can be started. It’s very common in Singapore to see a patient just before discharge getting the four pillars of beta-blocker, MRA, ARNi and SGLT2 inhibitor, because after discharge the patient is at a heightened risk of mortality and readmission within the next 30 days. Moreover, in the Asian setting as it is almost impossible to get a patient to come back within 30 days as the waiting list is very long, it is imperative to start the four drugs. It is very important to optimise the therapy that should protect them during the post-discharge vulnerable phase.
