September 2, 2026Critical Pathways in Cardiology A Journal of Evidence-Based Medicine
Sodium-Glucose Cotransporter-2 Inhibitor Use and Outcomes Following Transcatheter Aortic Valve Replacement: A Propensity-Score Matched Analysis
Why the study?
SGLT2 inhibitors improve outcomes across heart failure phenotypes, but their role in patients undergoing TAVR remains limited.
Does SGLT2i therapy reduce all-cause mortality and heart failure exacerbation in adults following transcatheter aortic valve replacement?
Key Points
- To evaluate the association between SGLT2 inhibitor therapy and clinical outcomes in patients undergoing transcatheter aortic valve replacement.
- Retrospective analysis of 55,147 adults undergoing TAVR (2019–2025) using the TriNetX Global Collaborative Network.
- Patients receiving SGLT2 inhibitors within 1 year post-TAVR were matched 1:1 using propensity scoring with controls across demographics, comorbidities, medications, and laboratory values (n=2,020 per group).
- At 1 year, SGLT2 inhibitor use was associated with a significant reduction in the composite primary endpoint of all-cause mortality and heart failure exacerbation (HR 0.74, 95% CI 0.69–0.80), heart failure exacerbations (HR 0.44, 95% CI 0.31–0.62), and all-cause rehospitalizations (HR 0.41, 95% CI 0.38–0.44).
- At 5 years, clinical benefits persisted, including an additional reduction in all-cause mortality (HR 0.84, 95% CI 0.73–0.97).
Study Design
Type
Cohort (n=55,147)
Multicenter
Yes
Structured PICO
Does SGLT2i therapy reduce all-cause mortality and heart failure exacerbation in adults following transcatheter aortic valve replacement?
P
Population
55,147 adults undergoing TAVR between 2019 and 2025, with 4,040 propensity-matched patients analyzed for outcomes up to 5 years.
E
Exposure
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) received within 1-year post-TAVR.
C
Comparator
Propensity-score matched controls not receiving SGLT2i.
O
Outcome
Composite of all-cause mortality and heart failure exacerbation.composite
Main Result
Hazard Ratio: 0.74 (95% CI 0.69–0.8)
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Given the involvement of SGLT2 in the pathological phenotype of diseased aortic valves, it is plausible that the beneficial effects of SGLT2 inhibitors observed in this study may be mediated, at least in part, by mitigating the deleterious role of the native valve. Studies specifically investigating the impact of SGLT2 inhibitors on transcatheter heart valve durability are warranted.”
“Based on our study, if you have a patient undergoing TAVI who is at risk of heart failure, it is important to treat them with dapagliflozin or another SGLT-2 inhibitor. These are safe drugs and have a lot of benefit.”
DBDeepak BhattDirector, Mount Sinai Fuster Heart Hospital, New York
“I know for me it will be practice changing when I go back to New York next week. I think I am pretty good about making sure that those without contraindications are discharged on an SGLT2 inhibitor. But I must say, in my TAVI or TAVR patients, that's not [been] part of the checklist.”
Implication
SGLT2i therapy after TAVR is associated with significant reductions in mortality, heart failure exacerbations, and rehospitalizations, suggesting a potential role for this therapy in post-TAVR management.
Abstract
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve outcomes across all heart failure (HF) phenotypes, but their role in patients undergoing transcatheter aortic valve replacement (TAVR) remains limited. Methods: Using the TriNetX Global Collaborative Network, we identified all adults undergoing TAVR (2019–2025). Patients were divided into 2 groups - those receiving SGLT2i within 1-year post-TAVR and matched controls not receiving SGLT2i. Propensity-score matching was applied across demographics, comorbidities, medications, and labs. The primary endpoint was a composite of all-cause mortality and HF exacerbation. Secondary outcomes included major adverse cardiac and cerebrovascular events, ischemic stroke, acute myocardial infarction, and all-cause rehospitalization at 1 and 5 years. Results: Among 55,147 TAVR patients, 2,478 (4.5%) received SGLT2i. After 1:1 matching, 2,020 well-balanced patients per group were analyzed. At 1 year, SGLT2i use was associated with lower incidence of primary composite endpoint (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.69–0.80), HF exacerbation (HR 0.44, 95% CI 0.31–0.62), and all-cause rehospitalization (HR 0.41, 95% CI 0.38–0.44). Benefits persisted at 5 years with additional reduction in all-cause mortality (HR 0.84, 95% CI 0.73–0.97). Acute pancreatitis (falsification outcome) showed no association at both follow-ups. Conclusions: In a large multinational database, SGLT2i therapy after TAVR resulted in a significantly lower incidence of all-cause mortality or HF exacerbation.
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Cite This Study
Jain et al. (2026) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=55,147). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. Matched controls not receiving SGLT2i was evaluated on Composite of all-cause mortality and HF exacerbation (HR 0.74, 95% CI 0.69-0.80).