住院患者钠-葡萄糖协同转运蛋白 2 抑制剂用于治疗急性心力衰竭的评估。
Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure.
机构信息
Division of Internal Medicine, University of Miami Health System, Miami, Florida.
Division of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida.
出版信息
Am J Cardiol. 2024 Jan 15;211:175-179. doi: 10.1016/j.amjcard.2023.11.005. Epub 2023 Nov 8.
Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. This study aimed to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use is safe in patients hospitalized for acute HF and whether its use is associated with improved clinical outcomes. We conducted a single-center, retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into 2 matched groups based on inpatient SGLT2I use. The matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. A total of 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, whereas 9 (8.2%) were treated with empagliflozin. The mean age was 71 years, 37.7% were women, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. The length of stay was 10 days in the SGLT2I group and 11 days in the control group (p = 0.43). A total of 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio 0.15, 95% confidence interval [CI] 0.03 to 0.66, p = 0.012). A total of 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio 1.58, 95% CI 0.74 to 3.37, p = 0.239). In addition, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had an HF readmission within 30 days (hazard ratio 3.75, 95% CI 1.05 to 13.44, p = 0.042). Acute kidney injury (54.5% vs 18.2%, p <0.001) and hypotension (12.7% vs 2.7%, p = 0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, the rate of 30-day HF readmission increased.
因急性心力衰竭（HF）住院是开始和调整指南指导的医学治疗的重要机会。本研究旨在确定钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2I）在因急性 HF 住院的患者中使用是否安全，以及它的使用是否与改善临床结局相关。我们进行了一项单中心、回顾性队列研究，纳入了任何射血分数的急性 HF 住院成人患者，并根据住院期间 SGLT2I 使用情况将他们分为 2 组匹配。匹配后，SGLT2I 组有 110 例患者，对照组有 110 例患者。SGLT2I 组共有 101 例（91.8%）患者接受达格列净治疗，9 例（8.2%）患者接受恩格列净治疗。SGLT2I 组的平均年龄为 71 岁，37.7%为女性，70.9%为白人，22.7%为黑人，64.1%为西班牙裔或拉丁裔。SGLT2I 组的住院时间为 10 天，对照组为 11 天（p=0.43）。SGLT2I 组有 2 例（1.8%）患者和对照组有 13 例（11.8%）患者在出院后 30 天内死亡（风险比 0.15，95%置信区间 [CI] 0.03 至 0.66，p=0.012）。SGLT2I 组有 17 例（15.5%）患者和对照组有 11 例（10.0%）患者在 30 天内因任何原因再次入院（风险比 1.58，95%CI 0.74 至 3.37，p=0.239）。此外，SGLT2I 组有 11 例（10.0%）患者和对照组有 3 例（2.7%）患者在 30 天内心力衰竭再入院（风险比 3.75，95%CI 1.05 至 13.44，p=0.042）。急性肾损伤（54.5% vs 18.2%，p<0.001）和低血压（12.7% vs 2.7%，p=0.005）在对照组中更常见。总之，因急性 HF 住院的患者使用 SGLT2I 与 30 天全因死亡率降低以及急性肾损伤和低血压发生率降低相关；然而，HF 再入院率增加。
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