SGLT2i‑treated heart failure patients with a reduced ejection fraction: A meta‑analysis

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Heart failure (HF) with reduced ejection fraction (HFrEF) is a major cause of morbidity and mortality.
• Identifying effective therapeutic strategies for HFrEF is crucial, especially for patients with or without diabetes mellitus.

Purpose of the Study:

• To systematically review and meta-analyze the effects of Sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular outcomes in patients with HFrEF.
• To assess the impact of SGLT2i on HF hospitalization, cardiovascular death, and all-cause mortality in this patient population.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) comparing SGLT2i with placebo in HFrEF patients was performed.
• Studies were identified through comprehensive searches of PubMed, Web of Science, and EMBASE databases up to July 2021.
• Pooled effects were estimated using odds ratios (OR) and 95% confidence intervals (CI) with fixed- or random-effects models, and sensitivity analyses were conducted.

Main Results:

• Five RCTs involving HFrEF patients were included in the meta-analysis.
• SGLT2i significantly reduced the risk of hospitalization for HF/cardiovascular death (OR=0.72), cardiovascular death (OR=0.84), hospitalization for HF (OR=0.69), and all-cause mortality (OR=0.79) compared to placebo.
• Results were consistent across sensitivity analyses, indicating the robustness of the findings.

Conclusions:

• SGLT2 inhibitors are effective in reducing the risk of HF hospitalization, cardiovascular death, and all-cause mortality in patients with HFrEF.
• The beneficial effects of SGLT2i extend to patients with HFrEF irrespective of their diabetes status.
• These findings support the use of SGLT2i as a foundational therapy for managing HFrEF.