What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute heart failure (n=1831). Intervention: SGLT2 inhibitors vs. Placebo. Primary outcome: Rehospitalization for heart failure (OR 0.52, 95% CI 0.42, 0.65).

February 5, 2022Open Access

Efficacy and safety of sodium-glucose cotransporter 2 inhibitors initiation in patients with acute heart failure, with and without type 2 diabetes: a systematic review and meta-analysis

Key Result

Initiation of SGLT2 inhibitors in patients hospitalized for acute heart failure reduced the risk of rehospitalization for heart failure by 48% (OR 0.52) compared to placebo.

Study Design

Type

Meta-Analysis (n=1,831)

Structured PICO

Does initiation of SGLT2 inhibitors reduce rehospitalization and improve outcomes in patients hospitalized for acute heart failure?

Population

1,831 patients from 3 RCTs hospitalized for acute heart failure (AHF), with and without type 2 diabetes.

Intervention

Initiation of SGLT2 inhibitors during hospitalization or early post-discharge (within 3 days)

Comparator

Placebo

Outcome

All-cause mortality, rehospitalization for heart failure, and improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) scale score

Initiation of SGLT2 inhibitors in patients hospitalized for acute heart failure safely reduces the risk of heart failure rehospitalization and improves patient-reported outcomes.

Main Result

Effect estimate: OR 0.52 (95% CI 0.42, 0.65)

Limitations

Published summary data rather than individual patient level data were used
Different versions of the KCCQ score were used across trials
Variable follow-up periods ranging from 60 days to more than 9 months
SOLOIST-WHF allowed inclusion of patients receiving the first dose of SGLT2 inhibitor up to 3 days after discharge

Abstract

Abstract Background There is uncertainty and limited data regarding initiation of sodium-glucose cotransporter 2 (SGLT2) inhibitors among patients hospitalized with acute heart failure (AHF). This systematic review and meta-analysis aim to establish the efficacy and safety of SGLT2 inhibitors initiated in patients hospitalized for AHF. Methods PubMed/Medline, Embase, and Cochrane library were searched using the following terms: (“sglt2" and "acute heart failure") and (“sglt2" and "worsening heart failure") from inception till November 15th, 2021 for randomized controlled trials (RCTs) comparing the efficacy and safety of initiating an SGLT2 inhibitor compared with placebo in patients with AHF. Major cardiovascular and diabetes scientific meetings in 2021 were also searched for relevant studies. Prespecified efficacy outcomes were all-cause mortality, rehospitalization for heart failure, and improvement in Kansas City Cardiomyopathy Questionnaire (KCCQ) scale score. Prespecified safety outcomes were acute kidney injury (AKI), hypotension, and hypoglycemia. Random effects odds ratio (OR) and mean difference with 95% confidence intervals (CIs) were calculated. Results Three RCTs with a total of 1831 patients were included. Initiation of SGLT2 inhibitors in patients with AHF reduced the risk of rehospitalization for heart failure (OR 0.52; 95% CI 0.42, 0.65) and improved Kansas City Cardiomyopathy Questionnaire scores (mean difference 4.12; 95% CI 0.1.89, 6.53). There was no statistically significant effect for initiation of SGLT2 inhibitors in patients with AHF on all-cause mortality (OR 0.70; 95% CI 0.46, 1.08). Initiation of SGLT2 inhibitors in patients with AHF did not increase the acute kidney injury (OR 0.76; 95% CI 0.50, 1.16), hypotension (OR 1.17; 95% CI 0.80, 1.71), or hypoglycemia (OR 1.51; 95% CI 0.86, 2.65). Conclusion Initiation of SGLT2 inhibitors in patients hospitalized for AHF during hospitalization or early post-discharge (within 3 days) reduces the risk of rehospitalization for heart failure and improves patient-reported outcomes with no excess risk of adverse effects.

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