SGLT2 inhibitors with conventional diuretics lower all-cause mortality in HF patients

A systematic review of nine randomized controlled trials found that the addition of SGLT2 inhibitors (SGLT2i) to conventional diuretic therapy for acute heart failure (AHF) was associated with a reduction in all-cause death and readmissions for heart failure. SGLT2i also increased daily urinary output and decreased the need for loop diuretics without worsening renal function. These findings were published in Clinical Research in Cardiology Journal.

SGLT2i are a type of medication that are commonly used to treat type 2 diabetes. However, recent research has suggested that they may also have benefits for people with heart failure. To investigate this further, a team led by Pedro Carvalho conducted a systematic review of nine randomized controlled trials involving 2,824 patients with AHF.

The study's methods involved a systematic search of three electronic databases to identify eligible trials. The primary outcome of the study was all-cause death, and secondary outcomes included readmissions for heart failure, the composite of cardiovascular death and readmissions for heart failure, daily urinary output, and the need for loop diuretics.

The findings of the study:

The addition of SGLT2i to conventional therapy for AHF reduced all-cause death (odds ratio [OR] 0.75; 95% CI 0.56–0.99; p = 0.049), readmissions for heart failure (OR 0.54; 95% CI 0.44–0.66; p < 0.001), and the composite of cardiovascular death and readmissions for heart failure (hazard ratio 0.71; 95% CI 0.60–0.84; p < 0.001).

SGLT2i also increased mean daily urinary output in liters (mean difference [MD] 0.45; 95% CI 0.03–0.87; p = 0.035) and decreased mean daily doses of loop diuretics in mg of furosemide equivalent (MD -34.90; 95% CI [− 52.58, − 17.21]; p < 0.001) without increasing the incidence of worsening renal function (OR 0.75; 95% CI 0.43–1.29; p = 0.290). 

Reference:

Carvalho, P. E. P., Veiga, T. M. A., Simões e Silva, A. C., Gewehr, D. M., Dagostin, C. S., Fernandes, A., Nasi, G., & Cardoso, R. (2023). Cardiovascular and renal effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of randomized controlled trials. In Clinical Research in Cardiology. Springer Science and Business Media LLC. https://doi.org/10.1007/s00392-022-02148-2