Sodium-Glucose Cotransporter-2 Inhibitor Use is Associated with a Reduced Risk of Heart Failure Hospitalization in Patients with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes Mellitus: A Real-World Study on a Diverse Urban Population

Abstract

Background Limited evidence-based therapies exist for the management of heart failure with preserved ejection fraction (HFpEF). Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in patients with systolic heart failure (HFrEF) and type-2-diabetes mellitus (T2DM) is associated with improved cardiovascular (CV) and renal outcomes. Objective We sought to examine whether there is an association of SGLT2i use with improved CV outcomes in patients with HFpEF. Patients and methodsWe conducted a single-center, retrospective review of patients with HFpEF and T2DM. The cohort was divided into two groups based on prescription of a SGLT2i or sitagliptin. The primary outcome was heart failure hospitalization (HFH); secondary outcomes were all-cause hospitalization and acute kidney injury (AKI). Results After propensity score matching, there were 250 patients (89 in the SGLT2i group, 161 in the sitagliptin group), with a mean follow-up of 295 days. Univariate Cox regression analysis showed that the SGLT2i group had a reduced risk of HFH versus the sitagliptin group (hazard ratio (HR) 0.13; 95% confidence interval (CI) (0.05-0.36); p < 0.001). The SGLT2i group had a decreased risk of all-cause hospitalization (HR 0.48; 95% CI (0.33-0.70); p < 0.001) and SGLT2i had a lower risk of AKI (HR 0.39; 95% CI (0.20-0.74); p = 0.004). Conclusions The use of SGLT2is is associated with a reduced incidence of HFH and AKI in patients with HFpEF and T2DM.

Preventing all‐cause hospitalizations in type 2 diabetes with sodium‐glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: A narrative review and proposed clinical approach

“… 44‐47 Importantly, these studies used an active comparator design. Thus, SGLT2 inhibitor initiators were at lower risk of ACHA compared with initiators of other GLAs, mainly dipeptidyl peptidase‐4 (DPP‐4) inhibitors 44‐47 …”

“…Furthermore, SGLT2 inhibitor use in real‐world settings was associated with reductions in the number of emergency room and outpatient visits ( Table 1 ). 44‐47 Importantly, these studies used an active comparator design. Thus, SGLT2 inhibitor initiators were at lower risk of ACHA compared with initiators of other GLAs, mainly dipeptidyl peptidase‐4 (DPP‐4) inhibitors 44‐47 …”

“…Thus, SGLT2 inhibitor initiators were at lower risk of ACHA compared with initiators of other GLAs, mainly dipeptidyl peptidase-4 (DPP-4) inhibitors. [44][45][46][47]…”

Impact of dapagliflozin treatment on renal function and diuretics use in acute heart failure: a pilot study

“…The study was stopped earlier than planned, but SOLOIST-WHF for the first time in the randomised controlled trial (RCT) demonstrated a reduction in major combined endpoints such as HF hospitalisations+cardiovascular death+urgent visits for worsening HF 45. Li et al showed that the use of SGLT2i was associated with a decrease in HHF, and the incidence of AKI in patients with HFpEF and TD2M 46. The possible beneficial effect of SGLT2i in HFpEF can be judged on the basis of the results of the EMPA-REG OUTCOME study, which evaluated the effectiveness of empagliflozin in patients with TD2M, with or without a reported history of HF.…”

“… 45 Li et al showed that the use of SGLT2i was associated with a decrease in HHF, and the incidence of AKI in patients with HFpEF and TD2M. 46 The possible beneficial effect of SGLT2i in HFpEF can be judged on the basis of the results of the EMPA-REG OUTCOME study, which evaluated the effectiveness of empagliflozin in patients with TD2M, with or without a reported history of HF. A predictive method was applied to the population in this trail, 47 according to which empagliflozin was shown to decrease mortality and HF hospitalisations, regardless of LVEF.…”