Sodium-Glucose Co-transporter 2 Inhibitors and Mycotic Genital or Urinary Tract Infections in Heart Failure.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) improve clinical outcomes in persons with heart failure (HF). This class of agents has been consistently associated with an increased risk of mycotic genital infections (MGIs), and in some, but not all trials, urinary tract infections (UTIs). Since other medications widely used for cardiac conditions do not cause MGIs and UTIs, cardiologists and their supporting teams will be encountering clinical questions that they previously did not have to address. This review provides clinicians with practical recommendations about SGLT2i use in individuals with HF as related to the associated MGI and possible UTI risk. Overall, given the benefit of SGLT2 inhibitors on clinical outcomes, the threshold for not initiating or discontinuing SGLT2i due to concerns for MGI or UTI should be high for persons with HF. Likewise, when SGLT2 inhibitors are discontinued for such concerns, the threshold for re-initiation should be low.