Sodium-Glucose Cotransporter-2 Inhibitors and Health-Related Quality of Life Outcomes in All Types of Heart Failure: A Systematic Review and Meta-Analysis

Introduction: Exercise intolerance in patients with heart failure (HF) leads to a lower quality of life. An increasing number of studies suggest that early initiation of guided-directed medical therapy (GDMT) leads to better outcomes. Sodium-glucose cotransporter-2 (SGLT-2) inhibitor is one of the cornerstones in HF treatment, but its effectiveness in improving quality of life remains uncertain. Methods: A comprehensive search of randomized controlled trials (RCT) was conducted. Outcome measures for cardiovascular death and HF symptoms using the Kansas City Cardiomyopathy Questionnaire - Total Symptom Score (KCCQ-TSS) in the early phase of treatment and at 8 months were analyzed using the Review Manager V5.4. The KCCQ-TSS ranges from 0 to 100, with higher scores indicating fewer symptoms and physical limitations associated with HF. The treatment effect was shown as a win ratio, in which a value greater than 1 indicates superiority. Results: Five RCTs were included in the meta-analysis. There was improvement in HF symptoms based on the KCCQ-TSS (HR 3.39 [95%CI: 2.95-3.89]I2 = 68%, p<0.00001) with substantial heterogeneity. The major source of heterogeneity identified was the interval when the KCCQ-TSS was performed, hence a subgroup analysis that specifically monitored patients during the eighth month of treatment was done, which showed improvement in HF symptoms (HR 3.16 [95%CI: 2.98-3.36)I2 = 8%, p<0.00001) in SGLT-2 inhibitors compared to placebo. Conclusion: The meta-analysis showed that initiation of SGLT-2 inhibitors resulted in improvement of HF symptoms which may lead to improvement of patients’ quality of life. Therefore, SGLT-2 inhibitors in all types of HF are effective in promoting better quality of life.