SPC365

Impact of SGLT2 inhibitors on cardiovascular outcomes in patients with heart failure with reduced ejection fraction

Session: Posters (Sessão 6 - Écran 4) - Insuficiência Cardíaca 6 - Inibidores SGLT1
Speaker: MARIANA GOMES TINOCO

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Tinoco; Ana Filipa Cardoso; Geraldo Dias; Tamara Pereira; Bebiana Faria; Filipa Almeida; Sérgio Leite; António Lourenço

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>B</strong><strong>ackground</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">DAPA-HF and EMPEROR-Reduced trials showed that SGLT2 inhibitors (SGLT2i) reduced primary outcome events (CV death or hospitalization for HF) in patients with HF with reduced ejection fraction (HFrEF). However, neither trial was powered to assess effects on CV death or all-cause death.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong> &nbsp;</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study aims to compare the effect of SGLT2i vs a control group without SGLT2i on CV outcomes in a real-world population.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We performed a retrospective study of patients with HFrEF observed at an HF clinic between Jan 2018 and Jun 2020, with a follow up (FUP) period until Oct 2021. One-to-one propensity score matching was used.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 211 HFrEF patients were included, of which 78 (37%) were medicated with SGLT2i. The final propensity-matched cohort included 58 pairs treated with SGLT2i vs a control group. <span style="background-color:white"><span style="color:black">Mean age was 65,9&plusmn;12,1 and 80,2% (93) were male.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">A total of 42,2% (49) of patients were treated with ACEI/ARB, 52,6% (61) with sacubitril-valsartan, 94% (109) with beta-blockers and 86,2% (100) with mineralocorticoid receptor antagonists. A total of 40,5% (47) of patients had an ICD and 29,3% (34) had a CRT-D.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a median FUP of 32,5 months (IQR 21-49), primary outcome events were lower in the SLGT2i group (16 patients; 27,6%) than in the control group (24 patients; 41,4%), however it was statistically non-significant (P=0,075). Hospitalizations for heart failure occurred in 15 (25,9%) patients in the SGLT2i group and in 17 (29,3%) patients in the control group (P=0,678).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Death from CV causes occurred in 2 patients (3,4%) in the SGTL2i group and in 9 patients (15.5%) in the control group (HR 0,210; 95% CI 0,045-0.971; p=0.046); 3 patients (5,2%) and 20 patients (34,5%), respectively, died from any cause (HR 0,143; 95% CI 0,042-0,480; p=0.002).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The effect of SLTG2i on all-cause mortality and CV mortality was consistent in patients regardless of the presence or absence of diabetes.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Disease-free survival was higher in the group treated with SGLT2i (1015 vs 878 days) but it was not statistically significant.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">These results are different from clinical</span></span> trials<span style="background-color:white"><span style="color:black"> which demonstrated a reduction in HF hospitalizations but not in CV mortality. </span></span>In this real-world population, those in SGLT2i group had a lower risk of CV and non-CV death, t<span style="background-color:white"><span style="color:black">ime to first hospitalization tended to be longer, with fewer hospitalizations for HF (although not statistically significant</span></span> <span style="background-color:white"><span style="color:black">which may be due to the number of the sample and the FUP time). </span></span></span></span></p>