SGLT2 inhibitors and outcomes in the chronic Post-LVAD phase: a multicenter real-world cohort study

Background The effect of sodium–glucose cotransporter-2 inhibitors (SGLT2i) in patients with left ventricular assist devices (LVAD) remains uncertain. We evaluated the association between SGLT2i use and adverse outcomes during the chronic post-LVAD phase. Methods We conducted a retrospective cohort study using the TriNetX network. Adults with LVAD implantation (2014–2025) who survived ≥90 days were included. SGLT2i exposure (empagliflozin or dapagliflozin) was identified by prescription records. A prespecified 90-day delayed outcome window defined follow-up from 3 months to 1 year after the index date. The primary outcome was a composite of all-cause mortality or heart failure exacerbation (HFE). Secondary outcomes included HFE, all-cause mortality, and major adverse kidney events (MAKE). Propensity score matching (1:1) and Cox regression were applied. Results After matching, 1,318 patients were included in each group. SGLT2i use was associated with a lower risk of the primary composite endpoint (20.0% vs. 30.6%; HR 0.65; 95% CI 0.56–0.76; p < 0.001). Risks of HFE (18.4% vs. 26.9%; HR 0.69; p < 0.001), all-cause mortality (4.2% vs. 7.3%; HR 0.60; p = 0.002), and MAKE (27.5% vs. 35.1%; HR 0.81; p = 0.003) were also lower. Safety outcomes were similar, including urinary tract infection (HR 0.69; p = 0.091) and diabetic ketoacidosis (HR 1.25; p = 0.437). Conclusion SGLT2i use was associated with lower risks of cardiovascular and kidney events in patients during the chronic post-LVAD phase, without increased adverse events. These findings support further evaluation of SGLT2i as part of long-term management after LVAD.