Clinical Considerations When Introducing Sodium-Glucose Co-Transporter 2 Inhibition in Patients With Heart Failure

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Discontinuation of medical therapy in heart failure (HF) due to adverse events (AE) is linked to increased mortality.
• Sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce HF risk in type 2 diabetes mellitus (T2DM) patients, but can cause AE upon initiation.

Purpose of the Study:

• To investigate factors associated with adverse events (AE) following the introduction of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in hospitalized patients with heart failure (HF) and type 2 diabetes mellitus (T2DM).
• To develop a predictive scoring system for AE to enable safe SGLT2i initiation in HF patients.

Main Methods:

• Sixty-four hospitalized patients with HF and T2DM receiving SGLT2i were analyzed.
• AE were defined as hypotension or a serum creatinine increase ≥0.3 mg/dL within five days of SGLT2i introduction.
• Logistic regression identified significant predictors of AE, leading to a scoring system development (AUC=0.83).

Main Results:

• 20.3% of patients experienced AE.
• Significant predictors for AE included female sex, hemoglobin ≥15.2 g/dL, serum creatinine ≥1.05 mg/dL, and cardiac index ≤2.15 L/min/m².
• A scoring system with a cut-off of 2 points effectively predicted AE.

Conclusions:

• Female sex, hemoconcentration, kidney injury, and low cardiac output are associated with AE during SGLT2i initiation in HF patients.
• The developed scoring system can facilitate the safe introduction of SGLT2i in this patient population.