Clinical outcomes of SGLT2 inhibitor use in Thai patients with heart failure: a five-year retrospective cohort study

Q: What are the key findings of this study?

SGLT2 inhibitors were associated with a significantly lower risk of the composite outcome of all-cause mortality and heart failure hospitalization (adjusted RR 0.60) compared to no SGLT2 inhibitor use.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=1378). Intervention: SGLT2 inhibitors (dapagliflozin or empagliflozin) vs. Non-SGLT2 inhibitor prescription. Primary outcome: Composite of all-cause mortality and hospitalization for worsening heart failure (adjusted RR 0.60, 95% CI 0.42-0.87, p=0.006).

Q: What does this research mean for the field?

SGLT2 inhibitors significantly reduce the risk of all-cause mortality and the composite of death or heart failure hospitalization in a real-world cohort of Thai patients with heart failure. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Thananan Chanchanayothin; Chuttikan Klomwong; Tanawit Saisri; Suphasin Panudom; Sakchai Chaiyamahapurk; Nonthikorn Theerasuwipakorn; Noppachai Siranart; Patavee Pajareya; Nattakorn Songsirisuk; Chalinee Pravarnpat; Akenarong Pipatputthapong; Pongpun Jittham; Paisit Kosum

doi:10.1016/j.ijcha.2026.101873

January 18, 2026IJC Heart & VasculatureOpen Access

Clinical outcomes of SGLT2 inhibitor use in Thai patients with heart failure: a five-year retrospective cohort study

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Key result

SGLT2 inhibitors linked to ~40% lower risk of mortality and heart failure hospitalization.

adjusted RR 0.60
95% CI 0.42-0.87
P=0.006
n=1,378

Figures

Why the study?

Although SGLT2 inhibitors demonstrated significant cardiovascular benefits in clinical trials, their real-world effectiveness in reducing all-cause mortality and heart failure hospitalization among heart failure patients in Thailand required evaluation.

Does SGLT2i therapy reduce the composite of all-cause mortality and hospitalization for worsening heart failure in patients newly diagnosed with heart failure?

Study Design

Type

Cohort (n=1,378)

Multicenter

No

Structured PICO

Does SGLT2i therapy reduce the composite of all-cause mortality and hospitalization for worsening heart failure in patients newly diagnosed with heart failure?

P

Population

1,378 adult patients newly diagnosed with heart failure at a tertiary care center in Thailand, evaluated over a 5-year retrospective study period.

E

Exposure

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), specifically dapagliflozin or empagliflozin, evaluated as a time-varying covariate based on prescription at outpatient visits.

C

Comparator

Non-SGLT2i exposure, evaluated as a time-varying covariate during periods when patients were not prescribed an SGLT2i at outpatient visits.

O

Outcome

Composite of all-cause mortality and hospitalization for worsening heart failure, identified through hospital admission records and death certificates and confirmed by blinded independent cardiologists.composite

Main Result

Relative Risk: 0.6 (95% CI 0.42–0.87)

Absolute Event Rate: 10.93% vs 17.58%

p-value: p=0.006

Limitations

Retrospective design limits causal inference and unmeasured confounders may remain.
Residual confounding may persist due to differences in background therapies such as ARNI and MRA.
Mortality data may have been underestimated due to incomplete death reporting without linkage to national death registration.
Non-standardized criteria for heart failure hospitalization in electronic health records may limit internal validity.
Approximately 10% of patients had less than three months of follow-up.
Data were collected from a single center, which limits generalizability to other regions or healthcare systems.
Retrospective design limits causal inference and may leave unmeasured confounders, including differences in background therapies like ARNI and MRA.
Mortality data may be underestimated due to loss to follow-up or incomplete reporting in electronic medical records without linkage to national registration.
Early censoring bias due to approximately 10% of patients having less than three months of follow-up.
Single-center data collection limits the generalizability to other regions or healthcare systems.

Implication

In a real-world Thai cohort, SGLT2 inhibitor use was associated with a significantly lower risk of death and heart failure hospitalization compared to periods without SGLT2 inhibitor exposure.

Abstract

Introduction & Objectives: Heart failure is one of the major public health concerns and a leading cause of hospitalization and mortality worldwide, including in Thailand. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated significant cardiovascular benefits in clinical trials. This study aimed to evaluate the real-world effectiveness of SGLT2i in reducing all-cause mortality and heart failure hospitalization among patients with heart failure at Naresuan University Hospital. Materials & Methods: This retrospective cohort study included patients newly diagnosed with heart failure at Naresuan University Hospital between January 1, 2019, and December 31, 2023. Patients were divided into those who received SGLT2i and those who did not. The primary outcome was a composite of all-cause mortality and hospitalization for worsening heart failure. Rate ratios were calculated using multilevel mixed-effects Poisson regression, adjusting for baseline characteristics. Results: A total of 1,378 patients were included (1,080 SGLT2i visits; 5,243 non-SGLT2i visits). The proportion of patients with reduced left ventricular ejection fraction (LVEF ≤ 40%) was higher in the SGLT2i group than the non-SGLT2i group (39.9% vs. 29.4%, p < 0.001). The SGLT2i group also had a higher prevalence of coronary artery disease, myopathy, and chronic kidney disease. Rate of composite outcome (death or heart failure hospitalization) was lower in the SGLT2i group (rate 10.93 per 100 vs. 17.58 per 100). The incidence of the composite outcome was significantly lower in the SGLT2i group compared to the non-SGLT2i group (rate ratio 0.60, 95% CI: 0.42-0.87; p = 0.006). The all-cause mortality rate in the SGLT2i group was markedly lower (rate ratio 0.02, 95% CI: 0.00-0.18; p = 0.001), while heart failure hospitalization showed a favorable trend without reaching statistical significance. Conclusion: SGLT2i were associated with a significantly lower risk of death and heart failure hospitalization in this real-world cohort of Thai heart failure patients. These findings reinforce the clinical benefits of SGLT2i and support their broader implementation in heart failure management in Thailand.

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Cite This Study

Chanchanayothin et al. (2026) conducted a cohort in Heart failure (n=1,378). SGLT2 inhibitors (dapagliflozin or empagliflozin) vs. Non-SGLT2 inhibitor prescription was evaluated on Composite of all-cause mortality and hospitalization for worsening heart failure (adjusted RR 0.60, 95% CI 0.42-0.87, p=0.006). SGLT2 inhibitors were associated with a significantly lower risk of the composite outcome of all-cause mortality and heart failure hospitalization (adjusted RR 0.60) compared to no SGLT2 inhibitor use.

synapsesocial.com/papers/6a1e9d7e6540130b7faf16d5 https://doi.org/10.1016/j.ijcha.2026.101873