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Transforming Heart Failure Management Nurse Strategies
Transforming Heart Failure Management With Nurse-Led Strategies and SGLT2 Inhibitors

Released: May 20, 2025

Expiration: May 19, 2026

Midge Bowers
Midge Bowers, DNP, FNP-BC, FAANP, FAAN, FACC
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Key Takeaways
  • SLGT2 inhibitors quickly reduce mortality and heart failure (HF) hospitalizations across the full spectrum of ejection fraction, making them foundational therapy for all patients with HF.
  • Nurses have a pivotal role in addressing patient concerns and counseling on potential adverse effects to support treatment adherence.
  • By recognizing the safety, tolerability, and ease of using SGLT2 inhibitors, nurses can help overcome clinical inertia by advocating for timely initiation in eligible patients. 

Why is it so important to focus on optimizing heart failure (HF) care with SGLT2 inhibitors? These therapies represent a major advancement in HF management by demonstrating significant reductions in both mortality and HF-related hospitalizations. What is particularly compelling is how rapidly they begin to work; clinical benefits often emerge within weeks after initiation. It is remarkable to have medications that not only help patients live longer, but also help them feel better faster. For patients whom we often refer to as “familiar faces”—those with frequent hospital admissions—SGLT2 inhibitors can truly change the trajectory of their care. 

SLGT2 Inhibitors: A Key Pillar of HF Management
All nurses should be familiar with the 4 guideline-directed pillars of HF therapy, especially for patients with an ejection fraction (EF) of ≤40%. SGLT2 inhibitors are now firmly established as one of those pillars. What is particularly exciting is that their indication has expanded beyond HF with reduced EF, and they are now recommended across the entire EF spectrum. Although initial studies focused on patients with reduced EF, recent evidence shows clear benefits in those with mildly reduced and even preserved EF, making these agents a foundational option for nearly all patients with HF.

One key advantage of SGLT2 inhibitors is that they do not require dose titration. Unlike traditional HF therapies such as β-blockers; renin-angiotensin-aldosterone system (RAAS) inhibitors; or mineralocorticoid receptor antagonists (MRAs), which require careful titration and frequent lab monitoring, SGLT2 inhibitors start at their target dose and do not require routine lab follow-up after initiation. For some patients, the need for repeat labs can be a barrier to starting a new medication, so this simplicity is a major win.

As nurses, we are often the first to review lab results, putting us in a critical position to assess whether a patient’s creatinine and estimated glomerular filtration rate are within the appropriate range for these therapies. In addition, the cardiorenal benefits of SGLT2 inhibitors—and their minimal effect on potassium—make them particularly appealing for patients with kidney impairment or hyperkalemia risk.

Another important benefit of SGLT2 inhibitors is their potential to reduce the need for loop diuretics. Because these agents promote glucose and sodium excretion through urine, patients often experience improved volume status, which may allow for diuretic dose reduction or even discontinuation. This is a meaningful consideration, as diuretics are background therapy in HF management and do not offer a mortality benefit.

If we can keep patients on the lowest effective dose, or move to as-needed diuretic use, it becomes a valuable strategy for optimizing overall care. This is an area where nurses and nurse practitioners can have a strong influence, helping other healthcare professionals (HCPs) consider when it is appropriate to reassess and possibly scale back diuretics once an SGLT2 inhibitor is started. Of course, this requires close monitoring to ensure patients adhere to therapy and maintain adequate hydration.

Nurse-Led Strategies in HF Care
Ultimately, it is essential that SGLT2 inhibitors are initiated—and initiated early—in the course of HF management. As nurses, we are in a unique position to advocate for these therapies, whether we are at the bedside, in the patient’s home, or in long-term care settings. The setting does not matter as much as the timing. What matters is promptly starting these evidence-based medications and supporting patients by ensuring that they understand the medication benefits. From their ease of use (no titration required) to their rapid impact on symptoms and outcomes, SGLT2 inhibitors are a vital part of modern HF care, and nurses fulfill a central role in driving that forward.

What are some of the common barriers patients face when starting SGLT2 inhibitors? Safety is a key concern. As we have discussed, one of the main mechanisms of SGLT2 inhibitors involves excreting excess glucose through the urine. Because of this, it is important for nurses to educate patients on proper genital hygiene to reduce the risk of yeast infections and urinary tract infections. These known adverse effects are typically manageable and treatable. Patients just need to be informed and prepared.

There is also the rare but serious risk of Fournier’s gangrene. Although I have not seen this in my practice, it is still our responsibility to mention it and help patients understand the signs to watch for. Even if patients do not ask directly about adverse effects, we need to initiate these conversations to support safe, informed use. Hydration is another important consideration. Whether or not a patient is on diuretics, nurses have a vital role in reinforcing the need for consistent hydration, especially for those living in hot climates or working outdoors.

Lastly, cost can be a significant barrier. Many patients express anxiety about the affordability of new medications. Exploring options like generics, manufacturer copay cards, and patient assistance programs can make a real difference. Whether you are a nurse, nurse practitioner, physician associate, or physician, helping patients navigate access challenges is a fundamental part of delivering equitable, effective care.

Call to Action: Initiating SGLT2 Inhibitor Therapy in HF
Although SGLT2 inhibitors were widely welcomed by HCPs and patients upon their approval for HF, prescribing rates still fall short of expectations. This is concerning, especially given the strong guideline support for early and comprehensive implementation of all 4 pillars of HF therapy. Of importance, SGLT2 inhibitors can be safely started alongside β-blockers, RAAS inhibitors, and MRAs. There is no need to delay initiation until other therapies are fully titrated. This flexibility allows for a more aggressive and timely approach to optimizing guideline-directed medical therapy.

To my fellow nurses and nurse practitioners caring for patients across the HF spectrum—whether HF with reduced EF, HF with midrange EF, or HF with preserved EF—I cannot stress this enough: SGLT2 inhibitors help patients feel better and live longer. They reduce cardiovascular mortality and prevent decompensation events. If patients are not yet receiving an SGLT2 inhibitor despite appearing stable and feeling well, it is a missed opportunity to improve long-term outcomes.

In my own practice, we routinely ask, “Why is this patient not on all 4 foundational therapies?” From there, we work as a team to identify how we can fulfill needs because, ultimately, these medications help patients thrive, stay out of the hospital, and extend their lives.

Your Thoughts
How frequently do you see patients with HF who do not yet have an SGLT2 inhibitor added to their treatment regimen? You can get involved in the discussion by answering the poll question and posting a comment below.

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How frequently do you see patients with HF who do not yet have an SGLT2 inhibitor added to their treatment regimen?

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