Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.
Funding Acknowledgements
Type of funding sources: None.
Introduction and objectives
There has been a continuous process of improvement after (ST-segment elevation myocardial infarction) STEMI. Our aim was to know whether patients < and ≥ 65 years suffering a STEMI can recover a life expectancy similar to that of the general population of the same age, sex and geographical region.
Methods
We included all patients who suffered a STEMI from January 2014 until January 2020 and compared them to a reference population provided by the National statistics Institute from Spain. For those patients surviving the acute event as well as the first 30 days, we calculated their observed survival, expected survival and the excess of mortality calculated with the Ederer II method. If the expected survival was inside the 95% confidence interval(CI) of the observed survival there was not a significant excess of mortality. We repeated all analyses for survivors stratifying by 65 years.
Results
We included 1722 patients, 899 patients were <65 years. For patients < 65 years who survived a STEMI, observed survival at 3 and 5 years of follow-up was 97.68%(95%CI, 96.05%-98.64%) and 94.14%(95%CI, 90.89%-96.25%), respectively. Expected survival for 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52%(95%CI, 82.23%-88.24%) and 75.43%(95%CI, 70.26%-79.83%), respectively. Expected survival for 3 and 5 years was 86.48% and 76.56%.
Conclusions
For survivors of the acute event, life expectancy is similar to that of the general population of the same age, sex and geographical region. Table 1Year of Follow UpObserved Survival (95% CI)Expected SurvivalAnual Excess of Mortality (95% CI)<65 yearsFirst Year99.23%(98.29%-99.65%)99.43%0.19%(-0.23%-1.14%)Second Year98.76%(97.61%-99.36%)98.79%-0.16%(-0.48%-0.84%)Third Year97.68%(96.05%-98.64%)98.12%0.36%(-0.25%-1.82%)Fourth Year95.82%(93.55%-97.31%)97.39%1.37%(0.27%-3.65%)Fifth Year94.14%(90.89%-96.25%)96.61%0.73%(-0.31%-3.88%))≥65 yearsFirst Year93.69%(91.59%-95.29%)95.64%2.15%(0.45%-4.39%)Second Year90.22%(87.61%-92.31%)91.09%-1.05%(-2.46%-1.12%)third Year85.52%(82.23%-88.24%)86.48%0.21%(-1.69%-3.06%)Fourth Year81.32%(77.38%-84.65%)81.80%-0.54%(-2.69%-3.06%)Fifth Year75.43%(70.26%-79.83%)76.56%1.20%(-2.17%6.98%)Abstract Figure 1
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