Key result
SGLT2 inhibitors linked to ~28% lower risk of death or worsening HF vs. sitagliptin.
Why the study?
The effectiveness of SGLT2 inhibitors in routine clinical practice for patients with heart failure was not extensively studied, particularly compared to sitagliptin, across SGLT2i agents, and by ejection fraction.
Do SGLT2 inhibitors reduce the composite of all-cause mortality, hospitalization for HF, or urgent HF visits in older adults with heart failure and type 2 diabetes compared to sitagliptin?
Cohort (n=59,605)
Yes
Do SGLT2 inhibitors reduce the composite of all-cause mortality, hospitalization for HF, or urgent HF visits in older adults with heart failure and type 2 diabetes compared to sitagliptin?
Hazard Ratio: 0.72 (95% CI 0.67–0.77)
Absolute Event Rate: 13.1% vs 17.4%
Absolute Risk Reduction: 4.3%
In routine US clinical practice, SGLT2 inhibitors are associated with a significantly lower risk of mortality and heart failure events compared to sitagliptin in older adults with heart failure and type 2 diabetes.
May support SGLT2 inhibitor preference over sitagliptin in older HF patients with T2D; leaves open need for randomized confirmation.
AIMS: The effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with heart failure (HF) in routine clinical practice is not extensively studied. This study aimed to evaluate the comparative effectiveness of SGLT2i vs. sitagliptin in older adults with HF and type 2 diabetes and to investigate whether there were any differences between agents within the SGLT2i class or for reduced and preserved ejection fraction. METHODS AND RESULTS: Using Medicare claims data (April 2013 to December 2019), 16 253 SGLT2i initiators vs. 43 352 initiators of sitagliptin aged ≥65 years with type 2 diabetes and HF were included. The primary outcome was a composite of all-cause mortality, hospitalization for HF or urgent visit requiring intravenous diuretics; secondary outcomes included its individual components. Propensity score fine stratification weighted Cox regression was used to adjust for 100 pre-exposure characteristics. Mean age was 74 years; 49.8% were women. Initiation of SGLT2i vs. sitagliptin was associated with a lower risk of the primary composite outcome [adjusted hazard ratio (HR) 0.72; 95% confidence interval 0.67-0.77]. The adjusted HRs were 0.70 (0.63-0.78) for all-cause mortality, 0.64 (0.58-0.70) for hospitalization for HF, and 0.77 (0.69-0.86) for urgent visit requiring intravenous diuretics. Similar associations with the primary composite outcome were observed for all three agents within the SGLT2i class, for reduced and preserved ejection fraction, and subgroups based on demographics, comorbidities, and other HF treatments. Bias-calibrated HRs for the primary endpoint using negative and positive control outcomes ranged between 0.81 and 0.89, suggesting that the observed benefit could not be fully explained by residual confounding. CONCLUSION: In routine US clinical practice, SGLT2i demonstrated robust clinical effectiveness in older adults with HF and type 2 diabetes compared with sitagliptin, with no evidence of heterogeneity across the SGLT2i class or across ejection fraction.
No takes yet. Share an insight, caveat, or question.
Fu et al. (2023) conducted a cohort in Heart failure and type 2 diabetes (n=59,605). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs. Sitagliptin was evaluated on Composite of all-cause mortality, hospitalization for heart failure, or urgent visit requiring intravenous diuretics (HR 0.72, 95% CI 0.67-0.77). Initiation of SGLT2 inhibitors was associated with a lower risk of the primary composite outcome of all-cause mortality or worsening heart failure compared with sitagliptin (HR 0.72).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: