Effect of Sodium-Glucose Cotransporter 2 Inhibitors for Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Zhou, Hufang; Peng, Wenhua; Li, Fuyao; Wang, Yuelin; Wang, Baofu; Ding, Yukun; Lin, Qian; Zhao, Ying; Pan, Guozhong; Wang, Xian

doi:10.3389/fcvm.2022.875327

Cited by 16 publications

(19 citation statements)

References 90 publications

(177 reference statements)

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“…Overall, the results of our meta-analysis are congruent with the findings of prior meta-analyses, demonstrating a significant benefit of SGLT2i in HFpEF patients (27,28). We included the DELIVER trial which is the largest RCT specifically conducted for HFpEF and HFmrEF patient population.…”

Section: Ef Diagnostic Thresholdsupporting

confidence: 80%

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors for heart failure with mildly reduced or preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Cheema,

Shafiee,

Athar

et al. 2023

Front. Cardiovasc. Med.

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AimsWe sought to conduct a meta-analysis to evaluate the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF).MethodsWe searched the Cochrane Library, MEDLINE (via PubMed), Embase, and ClinicalTrials.gov till March 2023 to retrieve all randomized controlled trials of SGLT2i in patients with HFpEF or HFmrEF. Risk ratios (RRs) and standardized mean differences (SMDs) with their 95% conﬁdence intervals (95% CIs) were pooled using a random-effects model.ResultsWe included data from 14 RCTs. SGLT2i reduced the risk of the primary composite endpoint of first HF hospitalization or cardiovascular death (RR 0.81, 95% CI: 0.76, 0.87; I2 = 0%); these results were consistent across the cohorts of HFmrEF and HFpEF patients. There was no significant decrease in the risk of cardiovascular death (RR 0.96, 95% CI: 0.82, 1.13; I2 = 36%) and all-cause mortality (RR 0.97, 95% CI: 0.89, 1.05; I2 = 0%). There was a significant improvement in the quality of life in the SGLT2i group (SMD 0.13, 95% CI: 0.06, 0.20; I2 = 51%).ConclusionThe use of SGLT2i is associated with a lower risk of the primary composite outcome and a higher quality of life among HFpEF/HFmrEF patients. However, further research involving more extended follow-up periods is required to draw a comprehensive conclusion.Systematic Review RegistrationPROSPERO (CRD42022364223).

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Section: Ef Diagnostic Thresholdsupporting

confidence: 80%

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors for heart failure with mildly reduced or preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Cheema,

Shafiee,

Athar

et al. 2023

Front. Cardiovasc. Med.

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“…Importantly, favourable changes in E/e ′ appear to have prognostic implications in HFpEF. In a recent meta-analysis, 19 SGLT2i were associated with a 1.22-unit (95% confidence interval 0.15-2.29; p = 0.03) reduction in E/e ′ in patients with HFpEF, an effect directly comparable to that reported for spironolactone in the meta-analysis by Ferreira and colleagues. SGLT2i agents are now known to have disease-modifying effects in HFpEF.…”

supporting

confidence: 61%

Improve heart function to improve heart failure outcomes: the disease‐modifying effects of spironolactone

Kalogeropoulos

Jacobs

2023

European J of Heart Fail

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“…Eight records were eliminated at this stage. Finally, 15 records (44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58) were included in this umbrella review. Figure 1 showed the literature screening procedure.…”

Section: Search Resultsmentioning

confidence: 99%

“…For the included SRs/MAs, in domain 2, 12 were assessed as low risk of bias (12/15, 80.00%) (44-46, 48-50, 52-56, 58), in domain 3, 11 were assessed as low risk of bias (11/15, 73.33%) (44, 46-51, 53, 55, 56, 58), and in domain 4, only 1 was assessed as low risk of bias (1/15, 6.67%) (56). In phase 3, 10 SRs/Mas had a low risk of bias (10/15, 66.67%) (45-48, [51][52][53][56][57][58]. The details of the ROBIS assessments were shown in Supplementary Table S4.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Scientific evidence of sodium-glucose cotransporter-2 inhibitors for heart failure with preserved ejection fraction: an umbrella review of systematic reviews and meta-analyses

Dai

Guan

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIt remains controversial whether sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are effective in treating heart failure with preserved ejection fraction (HFpEF).PurposeThe objective of this umbrella review is to provide a summary of the available evidence regarding the efficacy and safety of SGLT-2is for the treatment of HFpEF.MethodsWe extracted pertinent systematic reviews and meta-analyses (SRs/MAs) from PubMed, EMBASE, and the Cochrane Library that were published between the inception of the database and December 31, 2022. Two independent investigators assessed the methodological quality, risk of bias, report quality, and evidence quality of the included SRs/MAs in randomized controlled trials (RCTs). We further evaluated the overlap of the included RCTs by calculating the corrected covered area (CCA) and assessed the reliability of the effect size by performing excess significance tests. Additionally, the effect sizes of the outcomes were repooled to obtain objective and updated conclusions. Egger's test and sensitivity analysis were used to clarify the stability and reliability of the updated conclusion.ResultsThis umbrella review included 15 SRs/MAs, and their methodological quality, risk of bias, report quality, and evidence quality were unsatisfactory. The total CCA for 15 SRs/MAs was 23.53%, indicating a very high level of overlap. The excess significance tests did not reveal any significant results. Our updated MA demonstrated that the incidence of the composite of hospitalization for heart failure (HHF) or cardiovascular death (CVD), first HHF, total HHF, and adverse events as well as the Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and 6 min-walk distance (6MWD) were all substantially improved in the SGLT-2i intervention group compared to the control group. However, there was limited evidence that SGLT-2is could improve CVD, all-cause death, plasma B-type natriuretic peptide (BNP) level, or plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level. Egger's test and sensitivity analysis proved that the conclusion was stable and reliable.ConclusionsSGLT-2 is a potential treatment for HFpEF with favourable safety. Given the dubious methodological quality, reporting quality, evidence quality, and high risk of bias for certain included SRs/MAs, this conclusion must be drawn with caution.Systematic Review Registrationhttps://inplasy.com/, doi: 10.37766/inplasy2022.12.0083, identifier INPLASY2022120083.

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Effect of Sodium-Glucose Cotransporter 2 Inhibitors for Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Abstract: Graphical AbstractA systematic review and meta-analysis was performed to investigate the effect of sodium-glucose cotransporter 2 inhibitors for heart failure with preserved ejection fraction.

Cited by 16 publications

References 90 publications

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors for heart failure with mildly reduced or preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors for heart failure with mildly reduced or preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Improve heart function to improve heart failure outcomes: the disease‐modifying effects of spironolactone

Scientific evidence of sodium-glucose cotransporter-2 inhibitors for heart failure with preserved ejection fraction: an umbrella review of systematic reviews and meta-analyses

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