June 28, 2024Open Access
The effect of SGLT2 inhibitors on health status in patients with heart failure: a systematic review and meta-analysis
Key Result
SGLT2 inhibitors significantly improved the Kansas City Cardiomyopathy Questionnaire total symptom score at 12-16 weeks by a mean difference of 2.16 points compared to placebo in heart failure.
Study Design
Type
Meta-Analysis (n=23,679)
Multicenter
Yes
Structured PICO
Do SGLT2 inhibitors improve health status in patients with heart failure?
P
Population
23,679 patients with heart failure (including reduced or preserved ejection fraction, acute/worsening or chronic heart failure) pooled from 12 randomized clinical trials
I
Intervention
SGLT2 inhibitors
O
Outcome
Change in Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score (TSS), clinical summary score (CSS), and overall summary score (OSS) from baseline to 12-16 weeks, 32 weeks, and 52 weeks follow-uppatient reported
SGLT2 inhibitors provide consistent and sustained improvements in health status and symptoms across all heart failure subtypes within months of initiation.
Main Result
Effect estimate: MD 2.16 (95% CI 1.67-2.65)
p-value: p=<0.001
Limitations
- KCCQ data was missing for some participants
- Not all trials reported data for all KCCQ summary scores at all time points
- Treatment effects at 52 weeks were only reported by two trials
- Heterogeneity in how trials handle death of a participant before follow-up
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve health status in patients with heart failure (HF). We aim to evaluate the effect of SGLT2i on health status by Kansas City Cardiomyopathy Questionnaire (KCCQ) and if effect varied by ejection fraction (EF). Randomized clinical trials of SGLT2i in patients with HF till November 2022 were assessed. Change in KCCQ total symptom score (TSS), clinical summary score (CSS), and overall summary score (OSS) from baseline to 12-16 weeks, 32 weeks, and 52 weeks follow-up were assessed. Weighted mean differences (MD) in scores and odds ratios (OR) were pooled using a random-effects model. Twelve trials (n=23,679) were included. SGLT2i significantly improved KCCQ-TSS at 12-16 weeks [MD 2.16 (1.67, 2.65); p0.20 for all). SGLT2i improve health status in patients with HF, with consistent and sustained benefits across all summary scores and HF subtypes. Treatment benefits were apparent within months of initiation and sustained to at least 1 year.