In August the European Society of Cardiology held its annual scientific meeting, but this year, due to Covid-19, it was fully virtual.

One of the biggest news stories was the expanding evidence base to support the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors.

The EMPEROR-Reduced trial evaluated the effects of an SGLT2 inhibitor (empagliflozin 10 mg once daily vs. placebo) in 3,730 patients with heart failure and reduced left ventricular ejection fraction (LVEF ≤40%), with or without diabetes. During a median follow-up of 16 months, patients in the empagliflozin group had a lower risk of cardiovascular death or hospitalisation for heart failure than those in the placebo group, regardless of the presence or absence of diabetes.

In the DAPA-CKD trial, treatment with the SGLT2 inhibitor dapagliflozin cut the incidence of substantially worsened chronic kidney disease by an average of 39% compared with placebo when added to standard treatment. The level of benefit was similar in patients with and without diabetes. It also delayed the initiation of dialysis and reduced the number of deaths.

Some good news is that SGLT2 inhibitors will be funded by PHARMAC for diabetic patients in the next few months. The emerging evidence base of benefit in a non-diabetic population will likely be reflected in updated international guidelines, and will also need to be considered within New Zealand.

Another highlight of the meeting included the update of four ESC practice guidelines:

1. AF
2. NSTE-ACS
3. Sports Cardiology and Exercise in people with CVD
4. Adult congenital heart disease

Some key recommendations from the ESC AF Guidelines 2020:

- Diagnosis of clinical AF requires an ECG or a single-lead ECG tracing of ≥30 seconds.
- Novel technologies such as wearables, add to the diagnostic potential, but are still incompletely defined.
- For optimal management, structured characterisation of AF should be considered in all patients - clinical assessment of stroke risk, symptom status, burden of AF and evaluation of possible cause.
- Use of the Atrial Fibrillation Better Care (ABC) holistic pathway streamlines integrated care of AF patients across all healthcare levels and among specialties.
- Optimising shared decision-making about AF treatment options, and patient-reported outcomes should be routinely collected.

Overall, there is also greater emphasis on the need for lifestyle modifications and targeted therapy of intercurrent conditions.