Early Initiation of SGLT2 inhibitors Benefits Heart Failure Patients
Heart failure (HF) is a growing public health issue. The increasing burden of HF on health care is primarily due to an ageing population, as evidenced by the predominance of HF as a cause of hospitalization in individuals aged over 65 years. A recent study suggests that the sodium-glucose cotransporter-2 (SGLT2) inhibitors reduce hospitalizations for heart failure regardless of the presence of diabetes. The study findings were published in the Annals of Internal Medicine on April 12, 2022.
Previous studies have demonstrated the cardio-protective effect of SGLT2 inhibitors among adults with type 2 diabetes. New evidence suggests that these results could extend to people without diabetes. To further explore, Dr Sheyu Li and his team conducted a study to evaluate the effect of SGLT2 inhibitors in patients with heart failure, regardless of the presence of type 2 diabetes.
In a systematic review and meta-analysis, the researchers searched PubMed, Web of Science, Cochrane Library, and Embase (OVID interface) for eligible trials that randomly assigned adults with heart failure to SGLT2 inhibitors or control. They included overall, 8 trials with more than 15,000 participants. They reconstructed time-to-event individual patient data from published Kaplan–Meier plots and calculated time-varying risk ratios (RRs) in half-, 1-, and 2-year time frames. They further calculated anticipated absolute benefits using simple models applying relative effects to baseline risks.
Key findings of the study:
- Upon analysis, the researchers found that the sodium-glucose cotransporter-2 inhibitors reduce hospitalization for heart failure by 37% at 6 months, 32% at 1 year and 26% at 2 years (all high certainty) and reduce cardiovascular death by 14% at 1 year (high certainty).
- They noted that the low-certainty evidence did not indicate protection against all-cause death, kidney disease progression, or kidney failure.
- They observed that anticipated absolute benefits are greater for patients treated in the first year and for those with poorer prognoses, such as those newly diagnosed with heart failure in the hospital.
- However, they reported that the SGLT2 inhibitors doubled the risk for genital infections (RR, 2.69; high certainty).
The authors concluded, "Among people with heart failure, SGLT2 inhibitors reduce hospitalizations for heart failure regardless of the presence of diabetes; absolute benefits are most pronounced in first-year treatment and vary with prognostic factors. Clinicians should note the increased risk for genital infection in patients receiving SGLT2 inhibitors."
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DOI: https://doi.org/10.7326/M21-4284
