SPC365

SGLT2 inhibitor initiation in patients hospitalized for acute heart failure: does it still matter when patients are strictly followed after discharge?

Session: Comunicações Orais (Sessão 20) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker: Pedro Silvério António

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Pedro Silvério António; Sara Couto Pereira; Joana Brito; Pedro Alves da Silva; Beatriz Valente Silva; Catarina Oliveira; Beatriz Garcia; Margarida Martins; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; João Agostinho; Fausto j. Pinto; Dulce Brito

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: The EMPULSE Trial recently showed that starting empagliflozin in patients (pts) admitted due to acute heart failure (HF) led to significant reduction in 3-month HF hospitalizations and all-cause mortality. However real-world data regarding initiation of SGLT2 inhibitors (SGLT2i) during an HF hospitalization are scarce.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Quasi-experimental study comparing 3 groups: a group of clinically stable pts started on iSGLT2 during an HF admission included in a post-discharge HF follow-up program (FUPP) &ndash; SGLT2i group; a group of pts discharged after HF admission included in the FUPP &ndash; control group 1 (FUPPCG); and a group of pts discharged from an HF admission not in FUPP &ndash; control group 2 (CG2). Pts were matched for clinical characteristics in a 1:1:1 ratio. The co-primary endpoints were 1-year HF major events (all-cause mortality and HF hospitalization) and 1-year HF events (all-cause mortality, HF hospitalization, outpatient treated HF decompensation). Between groups, differences were established using Chi-square, Mann-Whitney test, Cox Regression and Kaplan-Meier analysis.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">From a total of 276 pts included in the FUPP, 29 pts met inclusion criteria in SGLT2i group. The 3 groups did not differ on baseline characteristics &ndash; Table 1.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">After a mean follow-up of 293&plusmn;111 days, there were no deaths in SGLT2i group and FUPPCG. Four (13.8%) pts died in the CG2. Major-HF events occurred in 3.4% in the SGLT2i group, 10.3% pts in FUPPCG and 48.3% pts in CG2, whereas HF events occurred in 3.4% in the SGLT2i group, 20.7% in FUPPCG and 62.1% in CG2.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On survival analysis there was no difference on HF major events incidence between the 2 groups and both had a lower rate of HF major events than CG2 (HR 0.29; 95%CI 0.14-0.625; p=0.002). Regarding HF events, there was a trend towards its reduction in SGLT2 group when comparing to FUPPCG (HR 0.14; 95%CI 0.02-1.17; p=0.07) and a significant reduction when comparing to CG2 (HR 0.4; 95%CI 0.22- 0.71; p=0.001). Differences between SGLT2i group and FUPPCG were mainly driven by a reduction in outpatient treated HF decompensations (HR 0.11; 95%CI 0.01&mdash;0.9; p=0.036).</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: This small study shows that starting SGLT2i in pts hospitalized due to acute HF may be beneficial in reducing HF events as seen on EMPULSE Trial. Despite the benefit hampering by the inclusion in an HF FUPP, there were still more outpatient treated HF decompensation when SGLT2i was not initiated, showing that, although FUPP is highly effective, there is still some prognostic benefit on inpatient SGLT2i initiation.</span></span></span></p>

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