Luis E. Echeverría , Lyda Z. Rojas , Angie Yarlady Serrano-García , Daniel R. Botero , María Cantillo-Reines , Adriana M. Jurado , Karen Andrea García-Rueda , Ángela Torres-Bustamante , Diana Ivonne Cañón-Gómez , Carolina Idrovo-Turbay , Robinson Sánchez-García , Jaime Alberto Rodríguez , Sergio A. Gómez-Ochoa
{"title":"早期开SGLT2抑制剂对急性缺损性心力衰竭结果的影响:真实世界的证据","authors":"Luis E. Echeverría , Lyda Z. Rojas , Angie Yarlady Serrano-García , Daniel R. Botero , María Cantillo-Reines , Adriana M. Jurado , Karen Andrea García-Rueda , Ángela Torres-Bustamante , Diana Ivonne Cañón-Gómez , Carolina Idrovo-Turbay , Robinson Sánchez-García , Jaime Alberto Rodríguez , Sergio A. Gómez-Ochoa","doi":"10.1016/j.recesp.2025.02.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in acute decompensated heart failure (ADHF), the extrapolability of clinical trial results to general populations remains limited. This study evaluated the impact of early in-hospital SGLT2i prescription on ADHF outcomes in a real-world setting.</div></div><div><h3>Methods</h3><div>Prospective cohort study. Adults with ADHF from a third-level cardiovascular center were included. The primary analysis compared early SGLT2i (prescribed within 48<!--> <!-->hours of admission) versus late SGLT2i (prescribed after 48<!--> <!-->hours). A secondary analysis included patients not receiving in-hospital SGLT2i. The primary outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay, 30-day improvement in the Minnesota Living with Heart Failure Questionnaire score, 30-day rehospitalization due to heart failure, and 30-day all-cause mortality.</div></div><div><h3>Results</h3><div>Of 2016 patients, early SGLT2i (≤<!--> <!-->48<!--> <!-->h) was initiated in 1275 (63.2%) patients, late SGLT2i in 346 (17.2%), and 395 (19.6%) did not receive in-hospital SGLT2i. After multivariate adjustment, early versus late SGLT2i use was associated with decreased in-hospital mortality (RR, 0.37; 95%CI, 0.17-0.77) and reduced hospital stay (mean difference −5.70 days; 95%CI, −7.05 to −4.34). Similarly, early versus late or no in-hospital SGLT2i use was associated with decreased in-hospital mortality (RR, 0.25; 95%CI, 0.14-0.44), reduced hospital stay (mean difference −2.99 days; 95%CI, −4.05 to −1.92), and lower 30-day combined mortality/heart failure rehospitalization (RR, 0.72; 95%CI, 0.53-0.98).</div></div><div><h3>Conclusions</h3><div>Early in-hospital SGLT2i prescription was associated with improved cardiovascular outcomes in ADHF in a real-world setting.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 9","pages":"Pages 780-788"},"PeriodicalIF":5.9000,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impacto de la prescripción temprana de inhibidores de SGLT2 en los resultados de la insuficiencia cardiaca aguda descompensada: evidencia del mundo real\",\"authors\":\"Luis E. Echeverría , Lyda Z. Rojas , Angie Yarlady Serrano-García , Daniel R. Botero , María Cantillo-Reines , Adriana M. Jurado , Karen Andrea García-Rueda , Ángela Torres-Bustamante , Diana Ivonne Cañón-Gómez , Carolina Idrovo-Turbay , Robinson Sánchez-García , Jaime Alberto Rodríguez , Sergio A. Gómez-Ochoa\",\"doi\":\"10.1016/j.recesp.2025.02.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and objectives</h3><div>Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in acute decompensated heart failure (ADHF), the extrapolability of clinical trial results to general populations remains limited. This study evaluated the impact of early in-hospital SGLT2i prescription on ADHF outcomes in a real-world setting.</div></div><div><h3>Methods</h3><div>Prospective cohort study. Adults with ADHF from a third-level cardiovascular center were included. The primary analysis compared early SGLT2i (prescribed within 48<!--> <!-->hours of admission) versus late SGLT2i (prescribed after 48<!--> <!-->hours). A secondary analysis included patients not receiving in-hospital SGLT2i. The primary outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay, 30-day improvement in the Minnesota Living with Heart Failure Questionnaire score, 30-day rehospitalization due to heart failure, and 30-day all-cause mortality.</div></div><div><h3>Results</h3><div>Of 2016 patients, early SGLT2i (≤<!--> <!-->48<!--> <!-->h) was initiated in 1275 (63.2%) patients, late SGLT2i in 346 (17.2%), and 395 (19.6%) did not receive in-hospital SGLT2i. After multivariate adjustment, early versus late SGLT2i use was associated with decreased in-hospital mortality (RR, 0.37; 95%CI, 0.17-0.77) and reduced hospital stay (mean difference −5.70 days; 95%CI, −7.05 to −4.34). 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Impacto de la prescripción temprana de inhibidores de SGLT2 en los resultados de la insuficiencia cardiaca aguda descompensada: evidencia del mundo real
Introduction and objectives
Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in acute decompensated heart failure (ADHF), the extrapolability of clinical trial results to general populations remains limited. This study evaluated the impact of early in-hospital SGLT2i prescription on ADHF outcomes in a real-world setting.
Methods
Prospective cohort study. Adults with ADHF from a third-level cardiovascular center were included. The primary analysis compared early SGLT2i (prescribed within 48 hours of admission) versus late SGLT2i (prescribed after 48 hours). A secondary analysis included patients not receiving in-hospital SGLT2i. The primary outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay, 30-day improvement in the Minnesota Living with Heart Failure Questionnaire score, 30-day rehospitalization due to heart failure, and 30-day all-cause mortality.
Results
Of 2016 patients, early SGLT2i (≤ 48 h) was initiated in 1275 (63.2%) patients, late SGLT2i in 346 (17.2%), and 395 (19.6%) did not receive in-hospital SGLT2i. After multivariate adjustment, early versus late SGLT2i use was associated with decreased in-hospital mortality (RR, 0.37; 95%CI, 0.17-0.77) and reduced hospital stay (mean difference −5.70 days; 95%CI, −7.05 to −4.34). Similarly, early versus late or no in-hospital SGLT2i use was associated with decreased in-hospital mortality (RR, 0.25; 95%CI, 0.14-0.44), reduced hospital stay (mean difference −2.99 days; 95%CI, −4.05 to −1.92), and lower 30-day combined mortality/heart failure rehospitalization (RR, 0.72; 95%CI, 0.53-0.98).
Conclusions
Early in-hospital SGLT2i prescription was associated with improved cardiovascular outcomes in ADHF in a real-world setting.
期刊介绍:
Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.