Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

Hyue Mee Kim; In‐Chang Hwang; Wonsuk Choi; Yeonyee E. Yoon; Goo-Yeong Cho

doi:10.1038/s41598-021-01759-5

November 16, 2021Scientific ReportsOpen Access

Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

View Full Paper

Ask AI

Bookmark

Share

Figures

Why the study?

ARNI and SGLT2i have shown benefits in diabetic patients with HFrEF, but their combined effect has not been revealed.

Does combination therapy with ARNI and SGLT2i reduce hospitalization for heart failure and cardiovascular mortality in diabetic patients with HFrEF?

Key Points

To assess the combined clinical and echocardiographic effects of ARNI and SGLT2 inhibitor therapy in diabetic patients with heart failure with reduced ejection fraction (HFrEF).
Retrospectively analyzed diabetic HFrEF patients categorized into four treatment arms: both ARNI and SGLT2i, ARNI only, SGLT2i only, or neither agent.
Evaluated outcomes after propensity score-matching (N=206) across a median follow-up of 27.6 months for heart failure hospitalization (HHF), cardiovascular mortality, and echocardiographic changes.
Across 206 matched patients followed for a median of 27.6 months, 92 patients (44.7%) had heart failure hospitalizations and 43 patients (20.9%) died from cardiovascular causes.
Dual therapy with ARNI and SGLT2i was associated with a lower risk of heart failure hospitalization and cardiovascular mortality compared to single-drug and non-user groups.

Structured PICO

Does combination therapy with ARNI and SGLT2i reduce hospitalization for heart failure and cardiovascular mortality in diabetic patients with HFrEF?

P

Population

206 propensity score-matched diabetic patients with heart failure with reduced ejection fraction (HFrEF)

I

Intervention

Combination therapy with Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose co-transporter-2 inhibitor (SGLT2i)

C

Comparator

ARNI alone, SGLT2i alone, or neither ARNI nor SGLT2i

O

Outcome

Occurrence of hospitalization for heart failure (HHF) and cardiovascular mortality at median 27.6 months follow-uphard clinical

Implication

Combination therapy with ARNI and SGLT2i in diabetic patients with HFrEF is associated with improved clinical outcomes and cardiac function compared to either therapy alone or neither.

Abstract

Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e' were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.