C-62 | Pooled Outcomes of SGLT2 Inhibitors in Acute Decompensated Heart Failure

Studies have shown variable results when sodium-glucose co-transporter 2 inhibitors (SGLT2i) are started during acute heart failure (HF). We conducted a meta-analysis to reconcile the data. Online databases were searched for randomized controlled trials (RCTs) comparing SGLT2i to control in patients admitted for acute decompensated HF. The outcomes of interest were diuretic response (weight change in kg/40mg furosemide equivalents), worsening HF, HF related readmissions, ketoacidosis, symptomatic hypotension, hypoglycemia and genitourinary tract infections. Pooled odds ratio (OR) and mean difference (MD) along with 95% confidence interval (CI) were calculated using a random-effects model. Six RCTs with a total of 1,108 patients (SGLT2i n=554, control n=554) were included. The mean age was 70 years, 61% were men, 53% had diabetes and mean duration of follow up was 41 days. As compared to control, the SGLT2i group had significant reduction of worsening HF (OR 0.43, 95% CI 0.20 to 0.96, p = 0.04) (Figure). The diuretic response (MD -0.08, 95% CI -0.20 to 0.03, p = 0.16), HF related readmissions (OR 0.85, 95% CI 0.52 to 1.39, p = 0.53), ketoacidosis (OR 0.32, 95% CI 0.01 to 8.02, p = 0.49), symptomatic hypotension (OR 0.69, 95% CI 0.29 to 1.64, p = 0.40), hypoglycemia and genitourinary tract infections were similar in the two groups. Initiation of SGLT2i during acute HF may reduce worsening HF without significant side effects when compared with control.