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Sodium-glucose cotransporter 2 inhibitors: the glue for heart failure with reduced ejection fraction foundational therapy
Session:
Posters (Sessão 6 - Écran 4) - Insuficiência Cardíaca 6 - Inibidores SGLT1
Speaker:
Sara Couto Pereira
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
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Authors:
Sara Couto Pereira; João r. Agostinho; Pedro Silvério António; Joana Brito; Pedro Alves da Silva; Beatriz Garcia; Ana Margarina Martins; Catarina Oliveira; Joana Rigueira; Rafael Santos; Nuno Lousada; Doroteia Silva; Fausto j. Pinto; Dulce Brito
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Hyperkaliemia is one of the major limiting factors for foundational therapy (FT) uptitration in heart failure with reduced ejection fraction (HFrEF) patients (pts). However, according to EMPEROR-Reduced Trial subanalysis, SGLT2 inhibitors (SGLT2i)<strong> </strong>may have an impact on reducing hyperkaliemia, allowing the introduction and maintenance of sacubitril/valsartan (ARNI) and mineralocorticoid receptor antagonists (MRA). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To evaluate the impact of SGLT2i on potassium levels (K) and, consequently, on </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">FT introduction and uptitration in HFrEF pts. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-center, retrospective study of HFrEF pts followed in an tertiary center HF clinic. Epidemiologic, clinical and echocardiographic data were recorded before and after SGLT2i initiation. The population was divided in 2 groups: pts treated with SGLT2i – SGLT2i group; and pts not treated with SGLT2i – control group. Hypokalemia was defined as K<3.5mmol/L, hyperkalemia as K>5.1mmol/L and severe hyperkalemia as K>5.9mmol/L. Both groups were compared using Chi-square and Mann-Whitney tests. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>275 pts were included, 176 (74%) in the SGLT2i group and 99 (36%) in the control group. The mean age was 66±14 years and 195 (70.7%) pts were males. Most pts had ischemic heart disease (45.7%) or dilated cardiomyopathy (41.7%) and were at NYHA functional class II (58.3%) or III (33%). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Pre-SGLT2i initiation clinical, laboratorial and therapeutic data are available in Table 1. There were no statistically significant differences between the two groups, apart from diabetes, that was more frequent in the SGLT2i group (p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up period of 47±96months, no statistically significant differences between the 2 groups regarding K, creatinine, eGFR and urea were observed (p=NS). In SGLT2i group there were no cases of hypokalemia (vs 4 cases in the control group; p=0.007); There were less cases of hyperkalemia in the SGLT2i group (42 (23.9%) versus 35 (35.4%) cases in control group (p=0.036)). Two cases of severe hyperkalemia (1.1% vs 2%; p=NS) were reported in both groups. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This difference in K may help to explain the higher prescription rate of ARNI (79% vs 38.4%; p<0.001) and MRA (90.3% vs 76.8%; p=0.002) in the SGLT2i group and also by its higher doses (p<0.001 and p=0.004, respectively) – Figure 1 and 2. </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Doses of diuretics and B-blocker were similar in both groups (p=NS). </span></span></p> <p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">This study suggests that introduction and uptitration of ARNI and MRA may be facilitated by concomitant administration of SGLT2i due to its effect in serum potassium levels.</span></span></p>
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