SPC365

Breaking Boundaries: Hemoglobin, Hematocrit and Heart Failure – The SGLT2 Inhibitor Connection

Session: SESSÃO DE POSTERS 43 - INSUFICIÊNCIA CARDÍACA E COMORBILIDADES
Speaker: Diogo Ferreira

Congress: CPC 2025
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Diogo Rosa Ferreira; Ana Abrantes; Fátima Salazar; Ana Francês; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto Pinto; Dulce Brito; João Agostinho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Evidence suggests SGLT2 inhibitors (SGLT2i) are associated with increased hemoglobin and hematocrit levels. This effect is particularly evident in patients with heart failure (HF), but it remains unclear whether these changes are independent of creatinine improvement and whether they correlate with prognosis.</span></span></span><br />
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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">To evaluate hemoglobin and hematocrit changes after SGLT2i introduction and their relation to prognosis in HF patients.</span></span></span><br />
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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Consecutive HF patients with reduced ejection fraction were followed in an outpatient clinic with protocol-based follow-up. The intervention group included 181 patients who began follow-up between 2020&ndash;23 and were prescribed SGLT2i. The control group included 150 patients who began follow-up between 2016&ndash;19 and did not receive SGLT2i in the first year. Group comparisons were made using Chi-square and Mann-Whitney tests. The prognostic impact of hemoglobin and hematocrit changes was assessed using Kaplan-Meier survival analysis and multivariable Cox regression.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The SGLT2i group had a mean age of 66 years, 27% female, and a baseline left ventricular ejection fraction (LVEF) of 28%. The control group was similar in age, sex, baseline LVEF, NT-proBNP, hemoglobin, hematocrit, and estimated glomerular filtration rate (eGFR). The mean follow-up time for the intervention group was 2.4 years.</span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">After one year of optimized medical therapy, both groups showed significant LVEF improvements (SGLT2i: 28% to 41%; control: 28% to 38%). The SGLT2i group also showed significant increases in hemoglobin (12.9 to 14.5 g/dL), hematocrit (39% to 43%), and eGFR (62 to 77 mL/min/1.73) &ndash; Figure 1. In contrast, these parameters remained unchanged in the control group &ndash; Table 1. The differences between groups were statistically significant (p&lt;0.001). Furthermore, in the SGLT2i group, hemoglobin and hematocrit increases were independent of eGFR improvements (p&lt;0.001).</span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Patients in the SGLT2i group who experienced hemoglobin increases had a 77% lower risk of cardiovascular mortality or HF hospitalization (HR: 0.23; 95% CI 0.01&ndash;0.48, p&lt;0.001). Similarly, patients with hematocrit increases had a 64% lower risk for the same outcome (HR: 0.36; 95% CI 0.16&ndash;0.78, p=0.008).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br />
<span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">These findings support a positive effect of SGLT2i on hemoglobin and hematocrit levels, independent of eGFR changes. These changes were associated with significant reductions in cardiovascular mortality and HF hospitalizations. Hematologic improvements may aid in prognostic stratification and predicting individual responses to SGLT2i therapy in HF. Further research is needed to explore underlying mechanisms.</span></span></span></p>

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