Clinical outcomes in heart failure patients with and without atrial fibrillation receiving sodium-glucose cotransporter-2 inhibitor

Mar 7, 2023Naunyn-Schmiedeberg's archives of pharmacology

Health results in heart failure patients with and without irregular heartbeat taking sodium-glucose transporter-2 inhibitors

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Abstract

SGLT2 inhibitors are associated with reduced risks of acute myocardial infarction, cardiovascular death, and all-cause mortality in heart failure patients.

Heart failure patients using SGLT2 inhibitors had an adjusted hazard ratio (HR) of 0.83 for acute myocardial infarction, indicating a lower risk compared to those not using the medication.
The risk of cardiovascular death was significantly reduced for SGLT2 inhibitor users, with an adjusted HR of 0.47.
All-cause mortality was lower among heart failure patients taking SGLT2 inhibitors, with an adjusted HR of 0.39.
Heart failure patients without atrial fibrillation who used SGLT2 inhibitors showed a reduced risk of adverse outcomes, with an adjusted HR of 0.48.
For heart failure patients with atrial fibrillation using SGLT2 inhibitors, the adjusted HR for adverse outcomes was 0.55, suggesting a protective effect.
A CHA2DS2-VASc score of less than 2 was associated with a greater risk reduction for adverse outcomes in SGLT2 inhibitor users.

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We report a retrospective analysis of a nationwide health database to study the association between sodium-glucose cotransporter-2 inhibitor (SGLT2I) use and the incidence of adverse clinical outcomes among heart failure (HF) patients with and without atrial fibrillation (AF) stratified by CHA2DS2-VASc score. The outcome of this study was on the development of adverse events, including acute myocardial infarction (AMI), hemorrhagic stroke, ischemic stroke, cardiovascular (CV) death, and all-cause mortality. By dividing the number of adverse events by the total person-years, the incidence rate was calculated. The hazard ratio (HR) was estimated by the Cox proportional hazard model. A total of 95% confidence interval (CI) was also presented to show the risk of adverse events for HF patients with and without AF taking SGLT2I. SGLT2I users had a lower risk of AMI (adjusted HR = 0.83; 95% CI = 0.74, 0.94), CV death (adjusted HR = 0.47; 95% CI = 0.42, 0.51), and all-cause death (adjusted HR = 0.39; 95% CI = 0.37, 0.41). Considering HF patients without AF and SGLT2I as the reference group, HF patients without AF but with SGLT2I had a reduced risk of adverse outcomes of 0.48 (95% CI = 0.45, 0.50), and HF patients with AF and SGLT2I had the decreased hazard ratio of 0.55 (95% CI = 0.50, 0.61). The adjusted HR of adverse outcomes for HF patients with CHA2DS2-VASc score less than 2 and SGLT2I without and with AF relative to HF patients without AF nor SGLT2I were 0.53 (95% CI = 0.41, 0.67) and 0.24 (95% CI = 0.12, 0.47), respectively. Compared to HF patients with no history of AF and SGLT2I, if patients additionally with SGLT2I and CHA2DS2-VASc score ≥ 2, the risk of the adverse outcomes was reduced with adjusted HR of 0.48 (95% CI = 0.45, 0.50); if patients additionally with AF and CHA2DS2-VASc score ≥ 2, the risk of the adverse outcomes was decreased with adjusted HR of 0.88 (95% CI = 0.80, 0.97); if patients additionally with AF, SGLT2I, and CHA2DS2-VASc score ≥ 2, the risk of the adverse outcomes was diminished with adjusted HR of 0.52 (95% CI = 0.47, 0.58). We concluded that SGLT2I has a protective effect in HF patients, and the risk reduction is greater with a score of < 2 and without AF.

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Clinical outcomes in heart failure patients with and without atrial fibrillation receiving sodium-glucose cotransporter-2 inhibitor

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