School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
Cardiovasc Diabetol. 2023 Jul 28;22(1):191. doi: 10.1186/s12933-023-01896-3.
Given the cumulative evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on chronic heart failure, demand is emerging for further information on their effects in patients who are hospitalized for acute heart failure. However, there is still limited evidence about the class effect of SGLT2is on acute heart failure. We investigated whether initiating treatment with SGLT2is after an episode of acute heart failure reduces the risks of post-discharge heart failure readmission or cardiovascular mortality among patients with type 2 diabetes.
A retrospective cohort study was conducted in a cohort of patients with type 2 diabetes who hospitalized for heart failure, using Korean Health Insurance Review & Assessment database (2015-2020). The exposure was defined as initiation of SGLT2is during hospitalization or at discharge. We assessed hazards of post-discharge heart failure readmission and cardiovascular death at 1-year, and 30-, 60-, and 90-day from the date of discharge in the SGLT2is users and non-users. Cox proportional hazards models with propensity score-based inverse probability of treatment weighting were used to estimate hazard ratios and 95% confidence intervals.
Among 56,343 patients with type 2 diabetes hospitalized for heart failure, 29,290 patients were included in the study cohort (mean [SD] age, 74.1 [10.8] years; 56.1% women); 818 patients (2.8%) were prescribed SGLT2is during index hospitalization or at discharge. Patients with a prescription for SGLT2i vs. those without prescription had lower rates of heart failure readmission or cardiovascular death at 1 year (22.4% vs. 25.3%; adjusted hazard ratio, 0.90 [95% confidence interval, 0.87-0.93]), and also at 30 days (7.0% vs. 7.7%%; 0.74 [0.69-0.79]).
Among patients with type 2 diabetes, initiating SGLT2i treatment after an episode of acute heart failure was significantly associated with a reduced combined risk of heart failure readmission and cardiovascular mortality in a nationwide cohort reflecting routine clinical practice.
鉴于钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）在慢性心力衰竭方面的有效性累积证据，人们对其在因急性心力衰竭住院的患者中的效果有了进一步的需求。然而，关于 SGLT2is 在急性心力衰竭方面的类效应的证据仍然有限。我们研究了在急性心力衰竭发作后开始 SGLT2is 治疗是否会降低 2 型糖尿病患者出院后心力衰竭再入院或心血管死亡率的风险。
使用韩国健康保险审查与评估数据库（2015-2020 年），对因心力衰竭住院的 2 型糖尿病患者进行了回顾性队列研究。暴露定义为住院期间或出院时开始使用 SGLT2is。我们评估了 SGLT2is 使用者和非使用者在出院后 1 年、30 天、60 天和 90 天的心力衰竭再入院和心血管死亡的风险。使用倾向评分逆概率治疗加权的 Cox 比例风险模型来估计风险比和 95%置信区间。
在因心力衰竭住院的 56343 例 2 型糖尿病患者中，纳入了 29290 例研究队列患者（平均[标准差]年龄为 74.1[10.8]岁；56.1%为女性）；818 例（2.8%）患者在指数住院期间或出院时开具了 SGLT2is。与未开具 SGLT2i 处方的患者相比，开具 SGLT2i 处方的患者在 1 年时心力衰竭再入院或心血管死亡的发生率较低（22.4% vs. 25.3%；调整后的风险比，0.90[95%置信区间，0.87-0.93]），在 30 天时也较低（7.0% vs. 7.7%；0.74[0.69-0.79]）。
在 2 型糖尿病患者中，在急性心力衰竭发作后开始 SGLT2i 治疗与在反映常规临床实践的全国性队列中降低心力衰竭再入院和心血管死亡率的综合风险显著相关。
