SGLT2 inhibitors in patients with heart failure with reduced ejection fraction
The administration of Sodium-glucose co-transporter-2 (SGLT2) inhibition was shown to reduce the composite endpoint of cardiovascular deaths or hospitalization for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) with or without diabetes. However, no data reports the effect of treatment on cardiovascular death or all-cause death or to characterize effects in clinically important subgroups. Ferreira and colleagues conducted an analysis titled “SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials” published in The Lancet Journal. The summary of this analysis can be studied below:
Objective:
To study the effect of SGLT2 inhibition on fatal and non-fatal heart failure events and renal outcomes in HFrEF patients and relevant subgroups from DAPA-HF and EMPEROR-Reduced trials.
Method:
DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin) are two wide-ranging studies that concluded the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with HFrEF with or without diabetes. This study includes the meta-analysis of both mentioned studies.
The subgroup for assessing the treatment effect on the combined risk of cardiovascular death or hospitalization for heart failure was formed based on inclusion criteria. The study included hazard ratios (HRs) and the Lin-Wei-Yang-Ying model for respective analysis.
Findings:
The study concludes reduced cardiovascular and all-cause death, hospitalization for heart failure, and serious adverse renal outcomes when appropriate treatment along with SGLT 2 inhibition with empagliflozin or dapagliflozin is provided. SGLT 2 inhibitors were well tolerated by patients in both studies. The benefits were reported to be consistent in different subgroups. The beneficial result of reduced cardiovascular death or hospitalization for heart failure is observed in even high-risk groups where eGFR is less than 60 mL/min per 1·73m².
Limitations:
Due to inaccessibility to individual patient data from DAPA-HF, the investigator reported that they only abled to evaluate subgroups and endpoints which were publicly available. As no correction of the multiplicity of subgroups was conducted, the authors add those subgroup findings should be considered as hypothetically generated findings.