Related Experiment Video
Updated: Jan 11, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Favorable outcomes of SGLT2 inhibitor use in pacemaker recipients: a population-based study
Yuval Avidan1, Asaf Danon2,3, Dana Hadar4
1Department of Cardiology, Lady Davis Carmel Medical Center, 7 Michal St., Haifa, Israel. Yuvalavidan10@gmail.com.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduced mortality and heart failure hospitalizations in pacemaker recipients. This finding suggests a protective role for SGLT2i in this patient group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Pacemaker recipients face an elevated risk of heart failure (HF).
- Preventive pharmacotherapy strategies for this population are not well-established.
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown efficacy in managing HF across diverse cardiometabolic conditions.
Purpose of the Study:
- To investigate the association between SGLT2 inhibitor therapy and clinical outcomes in patients implanted with pacemakers for atrioventricular block.
- To evaluate the impact of SGLT2i on mortality and HF hospitalizations post-pacemaker implantation.
Main Methods:
- Retrospective analysis of 11,518 patients receiving pacemakers between 2016-2024.
- Stratification based on baseline SGLT2i use, with exclusions for specific conditions and low eGFR.
- Propensity score matching to create balanced cohorts, followed by Cox regression analysis.
Main Results:
- Propensity score matching resulted in 1,226 SGLT2i users and 1,226 non-users.
- SGLT2i use was associated with a significant reduction in all-cause mortality (HR 0.62, P<0.001) over three years.
- SGLT2i use also significantly reduced HF hospitalizations (HR 0.50, P<0.001).
Conclusions:
- SGLT2 inhibitor therapy demonstrates a significant association with decreased all-cause mortality and HF hospitalizations after pacemaker implantation.
- These findings suggest a potential benefit of SGLT2i in pacemaker recipients.
- Further randomized controlled trials are warranted to confirm these observed associations.
Background:
Pacemaker recipients are predisposed to heart failure (HF), yet evidence guiding preventive pharmacotherapy in this population remains unexplored. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have redefined HF management across a broad spectrum of cardiometabolic phenotypes. This study evaluated the association between SGLT2i therapy and clinical outcomes after pacemaker implantation for atrioventricular block.
Methods:
Patients receiving conventional pacemakers between 2016 and 2024 were retrospectively analyzed and stratified by baseline SGLT2i therapy. Exclusions included sinus node dysfunction or iatrogenic pacing indications, single-chamber devices, and estimated glomerular filtration rate < 20 mL/min/1.73m2. Events within 3 months post-implantation were omitted to reduce peri-procedural confounding. After propensity score matching, Cox regression assessed associations between SGLT2i use and all-cause mortality and HF hospitalization.
Results:
Among 11,518 eligible patients, propensity score matching yielded two well-balanced cohorts of 1,226 SGLT2i users and non-SGLT2i users. Over three years, death occurred in 124 (10.1%) in the SGLT2i users and in 194 (15.8%) in the non-SGLT2i group (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.50 to 0.78; P < 0.001). HF hospitalization occurred in 132 (10.7%) in the SGLT2i group, and in 280 (22.8%) in the non-SGLT2i group (HR, 0.50; 95% CI, 0.41 to 0.62; P < 0.001). Subgroup analyses demonstrated consistent effects across strata.
Conclusions:
SGLT2i therapy was associated with reduced risk of all-cause mortality and HF-related hospitalizations following pacemaker implantation. Future randomized studies are needed to confirm this association.
Related Concept Videos
01:26Heart Failure Drugs: Inotropic Agents
01:29Cardiomyopathy V: Interprofessional Care