Initiation of sotagliflozin before discharge in diabetes patients with worsening HF improves outcomes

Heart failure (HF) is a most common disease characterized by variable durations of symptomatic stability often punctuated by episodes of worsening despite continued therapy. Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days. Sodium glucose cotransporter (SGLT) inhibitors decrease the risk of cardiovascular death and HF hospitalizations in patients with chronic HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF).

Researchers in a randomized study found that in patients with type 2 diabetes hospitalized for WHF who were started with sotagliflozin before discharge showed significant decrease in cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter treatment before discharge. The findings of the study are published in JAAC: Heart Failure.

The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization. The main endpoint of interest was cardiovascular death or HF-related event (HF hospitalization or urgent care visit) occurring within 90 and 30 days after discharge for the index WHF hospitalization. Treatment comparisons were by proportional hazards models, generating HRs, 95% CIs, and P values.

The key findings of the study are

• A total of 1,222 randomized patients, 596 received study drug on or before their date of discharge.

• Sotagliflozin reduced the main endpoint at 90 days after discharge (HR: 0.54 [95% CI: 0.35-0.82]; P = 0.004) and at 30 days (HR: 0.49 [95% CI: 0.27-0.91]; P = 0.023) and all-cause mortality at 90 days (HR: 0.39 [95% CI: 0.17-0.88]; P = 0.024).

• In subgroup analyses, sotagliflozin reduced the 90-day main endpoint regardless of sex, age, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or mineralocorticoid receptor agonist use.

• Sotagliflozin was well-tolerated but with slightly higher rates of diarrhea and volume-related events than placebo.

Researchers concluded that “Starting sotagliflozin before discharge in patients with type 2 diabetes hospitalized for WHF significantly decreased cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter treatment before discharge.”

Reference: Pitt B, Bhatt DL, Szarek M, et al. Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events: A Post Hoc Analysis of SOLOIST-WHF. JACC Heart Fail. 2023;11(8 Pt 1):879-889. doi:10.1016/j.jchf.2023.05.026