Authors: Weijia Li, Adarsh Katamreddy, Rachna Kataria, Merle L. Myerson & Cynthia C. Taub
Abstract
Background
Limited evidence-based therapies exist for the management of heart failure with preserved ejection fraction (HFpEF). Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in patients with systolic heart failure (HFrEF) and type-2-diabetes mellitus (T2DM) is associated with improved cardiovascular (CV) and renal outcomes.
Objective
We sought to examine whether there is an association of SGLT2i use with improved CV outcomes in patients with HFpEF.
Patients and methods
We conducted a single-center, retrospective review of patients with HFpEF and T2DM. The cohort was divided into two groups based on prescription of a SGLT2i or sitagliptin. The primary outcome was heart failure hospitalization (HFH); secondary outcomes were all-cause hospitalization and acute kidney injury (AKI).
Results
After propensity score matching, there were 250 patients (89 in the SGLT2i group, 161 in the sitagliptin group), with a mean follow-up of 295 days. Univariate Cox regression analysis showed that the SGLT2i group had a reduced risk of HFH versus the sitagliptin group (hazard ratio (HR) 0.13; 95% confidence interval (CI) (0.05–0.36); p < 0.001). The SGLT2i group had a decreased risk of all-cause hospitalization (HR 0.48; 95% CI (0.33–0.70); p < 0.001) and SGLT2i had a lower risk of AKI (HR 0.39; 95% CI (0.20–0.74); p = 0.004).
Conclusions
The use of SGLT2is is associated with a reduced incidence of HFH and AKI in patients with HFpEF and T2DM.
Key Points |
Patients with both heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes mellitus (T2DM) who were started on SGLT2 inhibitors (SGLT2is) are less likely to be hospitalized for heart failure exacerbation. |
SGLT2i use is associated with a lower risk of developing acute kidney injury among patients with T2DM and HFpEF. |
General internal medicine physicians are prescribing SGLT2is for T2DM and HFpEF patients more often than cardiologists. |