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Cardiovascular and renal effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of randomized
Pedro E P Carvalho1, Thiago M A Veiga1, Ana C Simões E Silva2
1Department of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
Insights
Adding SGLT2 inhibitors to standard diuretic therapy for acute heart failure significantly reduces deaths and hospital readmissions. This approach also boosts urine output while lowering loop diuretic dosage, without worsening kidney function.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Acute heart failure (AHF) management often involves standard diuretic therapy.
- The role of SGLT2 inhibitors (SGLT2i) in AHF alongside diuretics requires further investigation.
- Comparing outcomes with and without SGLT2i in AHF patients on diuretics is crucial.
Purpose of the Study:
- To compare cardiovascular outcomes, renal function, and diuresis in AHF patients receiving standard diuretic therapy with or without SGLT2i.
- To evaluate the efficacy and safety of adding SGLT2i to conventional treatment for AHF.
Main Methods:
- Systematic search of three electronic databases.
- Inclusion of nine eligible randomized controlled trials.
- Meta-analysis of data from 2,824 patients.
Main Results:
- SGLT2i addition reduced all-cause death (OR 0.75) and heart failure readmissions (OR 0.54).
- A composite of cardiovascular death and HF readmissions was also reduced (HR 0.71).
- SGLT2i increased daily urinary output (MD 0.45 L) and decreased loop diuretic doses (MD -34.90 mg furosemide equivalent) without impacting renal function.
Conclusions:
- SGLT2i combined with conventional diuretic therapy improves outcomes in AHF.
- The addition of SGLT2i enhances diuresis and reduces the need for higher loop diuretic doses.
- SGLT2i demonstrates a favorable safety profile regarding renal function in AHF patients.
Background:
We sought to compare cardiovascular outcomes, renal function, and diuresis in patients receiving standard diuretic therapy for acute heart failure (AHF) with or without the addition of SGLT2i.
Methods And Results:
Systematic search of three electronic databases identified nine eligible randomized controlled trials involving 2,824 patients. The addition of SGLT2i to conventional therapy for AHF reduced all-cause death (odds ratio [OR] 0.75; 95% CI 0.56-0.99; p = 0.049), readmissions for heart failure (HF) (OR 0.54; 95% CI 0.44-0.66; p < 0.001), and the composite of cardiovascular death and readmissions for HF (hazard ratio 0.71; 95% CI 0.60-0.84; p < 0.001). Furthermore, SGLT2i increased mean daily urinary output in liters (mean difference [MD] 0.45; 95% CI 0.03-0.87; p = 0.035) and decreased mean daily doses of loop diuretics in mg of furosemide equivalent (MD -34.90; 95% CI [- 52.58, - 17.21]; p < 0.001) without increasing the incidence worsening renal function (OR 0.75; 95% CI 0.43-1.29; p = 0.290).
Conclusion:
SGLT2i addition to conventional diuretic therapy reduced all-cause death, readmissions for HF, and the composite of cardiovascular death or readmissions for HF. Moreover, SGLT2i was associated with a higher volume of diuresis with a lower dose of loop diuretics.
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