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Early in-hospital use of SGLT2i in heart failure patients with ischemic etiology
Paolo Severino1, Andrea D'Amato2, Vincenzo Myftari2
1Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161, Rome, Italy. paolo.severino@uniroma1.it.
Insights
Early introduction of SGLT2 inhibitors (SGLT2i) significantly reduced cardiovascular death and heart failure hospitalizations in patients with ischemic heart disease. This early treatment strategy proved beneficial for acute coronary syndrome patients and those with de novo heart failure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are established treatments for heart failure (HF), irrespective of ejection fraction.
- Limited real-world data exist on SGLT2i efficacy in patients with HF and ischemic heart disease (IHD), particularly those with recent acute coronary syndrome (ACS) or de novo HF.
Purpose of the Study:
- To evaluate the 6-month occurrence of composite cardiovascular death (CV)/HF hospitalization (HFH), all-cause death, CV death, and HFH in patients with HF due to IHD.
- To assess the impact of early SGLT2i introduction during index hospitalization in patients with HF due to IHD, including those with recent ACS.
Main Methods:
- An observational, prospective, single-center study enrolled 222 patients with HF due to IHD.
- Patients were divided into two groups based on SGLT2i introduction timing: pre-discharge (G1) or post-discharge (G2).
- A sub-analysis focused on patients admitted for ACS.
Main Results:
- Early in-hospital SGLT2i introduction (G1) was associated with significantly reduced composite CV death/HFH (HR=0.24), all-cause death (HR=0.27), CV death (HR=0.32), and HFH (HR=0.31) compared to post-discharge introduction (G2).
- In ACS patients, pre-discharge SGLT2i treatment significantly lowered CV death/HFH, CV death, and all-cause death rates.
- De novo HF patients receiving SGLT2i during hospitalization showed a reduced rate of CV death/HFH.
Conclusions:
- Early in-hospital introduction of SGLT2i effectively reduces adverse cardiovascular outcomes in patients with ischemic cardiomyopathy.
- Initiating SGLT2i during hospitalization for ACS patients significantly improves survival and reduces HFH, although HFH reduction was not statistically significant in this subgroup.
- Early SGLT2i administration in de novo HF patients demonstrates a significant benefit in reducing the composite of CV death/HFH.
Purpose:
SGLT2i role in the treatment of heart failure (HF) regardless of clinical presentation and left ventricular ejection fraction (LVEF) has been widely proven and real-world data regarding patients with HF and ischemic heart disease (IHD) and, in particular with recent acute coronary syndrome (ACS) and de novo HF, are lacking. We aim to evaluate the occurrence of the composite of cardiovascular death (CV)/ HF hospitalization (HFH), all-cause death, CV death and HFH at 6 months follow up, in patients with HF due to IHD as well as in recent ACS who introduced SGLT2i during the index hospitalization.
Methods:
The present is an observational, prospective, single center study, enrolling patients with a diagnosis of HF due to IHD as primary etiology. According to SGLT2i introduction timing, two groups were created: pre-discharge (G1) or post-discharge (G2) introduction. A sub-analysis in patients admitted due to ACS has been performed.
Results:
A total of 222 consecutive patients have been enrolled from April 2022 to April 2024 and were followed-up for a period of 6 months. At multivariate Cox regression analysis, statistically significant differences have been observed between the two groups in terms of the composite CV death/HFH (HR = 0.24; 95%CI [0.101-0.564]; p = 0.001), all-cause death (HR = 0.27; 95% CI [0.100-0.725]; p = 0.009), CV death (HR = 0.32; 95%CI [0.101-0.999] p = 0.045) and HFH (HR = 0.31; 95%CI [0.098-0.963]; p = 0.043). Patients with ACS treated with SGLT2i before discharge showed a reduced rate of CV death/HFH (log-rank p = 0.008), CV death (log-rank p = 0.015) and all-cause death (log-rank p = 0.005) compared to patients who were not treated with SGLT2i before discharge. In this subpopulation, no differences have been observed in terms of HFH (log-rank p = 0.155). Significant differences in term of CV death/HFH (log-rank p = 0.039) have been observed in de novo HF patients, but not in terms of the other study endpoints.
Conclusions:
The early in-hospital introduction of SGLT2i reduced the occurrence of the composite CV death/HFH, all-cause death, CV death and HFH in patients with ischemic cardiomyopathy. In the subgroup analysis of patients admitted due to ACS, the introduction of SGLT2i during the index hospitalization resulted in a significant reduction of the composite CV death/HFH, CV death and all-cause death, but not in HFH. The same therapeutic strategy resulted in reduced rate of CV death/HFH in the de novo HF subpopulation.
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