What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic Heart Failure in Adult Congenital Heart Disease (n=287). Intervention: SGLT2 inhibitors vs. Standard combination HF therapy. Primary outcome: Change in New York Heart Association (NYHA) functional class (log OR 1.3, 95% CI 0.37-2.23, p=0.01).

December 2, 2024American Journal of Cardiovascular Drugs14 citationsOpen Access

A Systematic Review and Meta-Analysis of the Safety and Efficacy of SGLT2 Inhibitors in Chronic Heart Failure in ACHD Patients

BDBibhuti B. DasPediatric / Congenital Cardiology JNJianli NiuMemorial Healthcare System

Key Result

Adding SGLT2 inhibitors to standard heart failure therapy significantly improved NYHA functional class (log OR 1.3) in patients with adult congenital heart disease.

Study Design

Type

Meta-Analysis (n=287)

Structured PICO

Do SGLT2 inhibitors improve NYHA functional class and reduce NT-proBNP in adult congenital heart disease patients with heart failure?

Population

287 adults (mean age 38.5 years, 40% female) with chronic heart failure due to congenital heart disease, treated with SGLT2 inhibitors and followed for a median of 260 days.

Intervention

SGLT2 inhibitors supplementing guideline-directed medical therapy

Comparator

Standard combined therapies (baseline or control)

Outcome

Change in the New York Heart Association (NYHA) functional class (FC)patient reported

SGLT2 inhibitors appear safe and effective in improving functional class and reducing NT-proBNP in adult congenital heart disease patients with heart failure.

Main Result

Odds Ratio: 1.3 (95% CI 0.37–2.23)

p-value: p=0.01

Limitations

Predominantly comprised retrospective studies with limited sample sizes
Considerable diversity in CHD types and HF severity
Selection bias due to the absence of uniform echocardiographic parameters for determining ventricular dysfunction
Insufficient concealment of allocation, performance bias, and lack of blinding in outcome assessment
No uniform reporting of whether changes in SBP and Cr/eGFR levels were clinically significant
Gaps in information about the age at initial CHD repair, residual anatomical defects, and surgical history

Abstract

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have become a first-line therapy for heart failure (HF) in adults. However, data on their use in HF associated with adult congenital heart disease (ACHD) are limited. This systematic review and meta-analysis evaluated the safety, tolerability, and efficacy of SGLT2is in ACHD HF patients, supplementing guideline-directed medical therapy. METHODS: A comprehensive systematic search and meta-analysis were conducted on studies examining SGLT2i use in ACHD HF patients. The primary endpoint was the change in the New York Heart Association (NYHA) functional class (FC), with secondary endpoints including changes in ventricular function and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels. Additionally, the safety and tolerability of SGLT2is were evaluated. RESULTS: The meta-analysis included eight studies with 287 patients aged 19-67 years (median age 37.5 years). Adding SGLT2is to combined therapies significantly improved NYHA FC (log odds ratio 1.3, 95% confidence interval CI 0.37-2.23, p = 0.01) and reduced NT-proBNP levels (mean difference MD -0.43, 95% CI -0.70 to -0.16, p < 0.001). A notable decrease in systolic blood pressure was observed (MD -0.32, 95% CI -0.51 to -0.14, p = 0.00). The adverse effect profile was comparable to that seen in routine HF, with fewer HF hospitalizations post-SGLT2i initiation. Urinary tract infections occurred in 14 patients (5%), with no instances of hypoglycemia or ketoacidosis reported. Medication withdrawal due to adverse effects was noted in 19 patients (7%). CONCLUSIONS: SGLT2is are well tolerated in ACHD HF patients. Notably, SGLT2is improved NYHA FC and reduced NT-proBNP levels across a diverse ACHD HF patient cohort. However, further prospective, multicenter studies are needed to confirm the safety and efficacy of SGLT2is in this unique patient population.

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