Factors associated with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors after an episode of acute heart failure and prognostic impact

Abstract

Objectives

To analyze the factors associated with the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the association between use SGLT2i and post discharge adverse clinical endpoints (composite of 30-day visit to emergency department or acute heart failure -AHF- readmission or death) and 1-year mortality.

Methods

We included all patients diagnosed with AHF in 40 Spanish emergency departments (ED) in November-December 2022 with available data on chronic treatment and at discharge and grouped them according to whether they received iSGLT2 at discharge. Treatment with SGLT2i was categorized in never user, prior use and initiation during decompensation. In multivariable models adjusted for 31 independent variables, we investigated factors associated with iSGLT2 use at discharge and with new initiation of iSGLT2 treatment at discharge, and the relationship between iSGLT2 treatment and 30-day adverse events and 1-year mortality.

Results

3554 patients were included (median age: 85 years, 56% women, 71% hospitalized): 495 (13.9%) were already receiving iSGLT2 before decompensation and 733 (20.6%) were discharged with iSGLT2. The use of iSGLT2 at discharge was directly associated with prior iSGLT2 treatment, diabetes mellitus, hospitalization, and discharge prescription of other drugs recommended for heart failure, and inversely with previous episodes of AHF and dementia. Initiation of iSGLT2 during decompensation was inversely associated with these factors and also inversely associated with chronic renal failure. Treatment with iSGLT2 at discharge was associated with a lower risk of adverse events at 30 days (adjusted HR 0.80, 95%CI 0.65−0.99) and death at 1 year (0.78, 0.63−0.96). These beneficial effects were also observed when iSGLT2 was initiated during decompensation (0.65, 0.49−0.87; and 0.71, 0.54−0.93; respectively), and the reduction in adverse events at 30 days was even better in new-onset cases (interaction p: 0.02).

Conclusion

The use of iSGLT2 after an AHF episode is low, is higher in patients who were hospitalized, and is associated with fewer 30-day adverse events and deaths at 1 year compared with patients not receiving iSGLT2. Patients who initiate iSGLT2 during decompensation have an even greater decrease in 30-day adverse events than patients on chronic therapy.