Sodium-Glucose Cotransporter-2 Inhibitors at Discharge from Cardiology Hospitalization Department: Decoding A New Clinical Scenario

Abstract

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.

Impact of Canagliflozin in Patients with Type 2 Diabetes after Hospitalization for Acute Heart Failure: A Cohort Study

“…The percentages of patients with HF rehospitalization or cardiovascular death within 90 days were 22.1% in the control group and 11.1% in the empagliflozin group [ 28 ]. More recently, a cohort study of 104 consecutive patients discharged for acute heart failure and stratified by SGLT-2 inhibitors prescription concluded that these agents were safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths [ 29 ]. The comparative effectiveness of cardiovascular outcomes in new users of SGLT2 inhibitors (CVD-REAL) 2 study [ 30 ], which examined cardiovascular outcomes in a large international cohort with 2,581,980 patients with diabetes and initiated SGLT2 inhibitors versus other glucose-lowering drugs, observed over 441,357 person-years of follow-up, 2646 events of HF hospitalization in the SGLT2 inhibitors group and 3,351 in control group (HR: 0.64; 95% CI: 0.50 to 0.82; p = 0.001).…”

Management of Heart Failure with Reduced Ejection Fraction Globally and in Lebanon: Where Do SGLT-2is Stand?

“…Noteworthy, patients admitted to the hospital with acute HF decompensation will not need to stop SGLT2i medication [88], except if presenting with eGFR < 20 ml/min/1.73m 2 , cardiogenic shock or diabetic ketoacidosis. If the patient was not on SGLT2is, this treatment can be initiated after stabilization and predischarge [89]; or in the first post-discharge visit barring any contraindications or hypersensitivity.…”