Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
ESC Heart Fail. 2024 Feb;11(1):410-421. doi: 10.1002/ehf2.14597. Epub 2023 Nov 28.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown potential therapeutic benefits in heart failure (HF). However, data on their real-world usage and benefits in acute decompensated heart failure (ADHF) are limited.
We conducted a post hoc analysis of real-world data from 1108 patients with ADHF admitted to Nihon University Itabashi Hospital (Tokyo, Japan) between 2018 and 2022. Patients were divided into two groups based on the prescription of SGLT2 inhibitors during hospitalization: an SGLT2 inhibitor group (SGLT2i group) (n = 289) and a non-SGLT2i group (n = 819). The primary endpoints were death and rehospitalization for HF after discharge. The median age was 76 [interquartile range (IQR): 66, 83] years, and 732 patients (66%) were male. Data showed an increasing trend in the prescription of SGLT2 inhibitors since 2021. During a median follow-up period of 366 days (IQR: 116, 614), 458 (41.3%) patients reached the primary endpoint. The Kaplan-Meier analysis showed that the SGLT2i group had a significantly lower rate of composite events than the non-SGLT2i group, both overall (log-rank test, P < 0.001) and in the following left ventricular ejection fraction (LVEF) subgroups: HF with reduced ejection fraction (EF) (n = 413), HF with mildly reduced EF (n = 226), and HF with preserved EF (n = 466) (log-rank test; P = 0.044, P = 0.013, and P = 0.001, respectively). Furthermore, patients starting SGLT2 inhibitors during hospitalization had a significantly lower rate of composite events than those not using SGLT2 inhibitors (log-rank test, P < 0.001). This association was also significant in the LVEF subgroups (P = 0.005, P = 0.032, and P = 0.004, respectively).
The prescription and initiation of SGLT2 inhibitors during hospitalization are associated with improved post-discharge outcomes in patients with ADHF, irrespective of LVEF.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在心衰（HF）中显示出潜在的治疗益处。然而，关于其在急性失代偿性心衰（ADHF）中的实际应用和益处的数据有限。
我们对 2018 年至 2022 年间在日本埼玉大学板桥医院（东京）住院的 1108 例 ADHF 患者的真实世界数据进行了事后分析。根据住院期间 SGLT2 抑制剂的处方，患者分为 SGLT2 抑制剂组（SGLT2i 组）（n=289）和非 SGLT2 抑制剂组（n=819）。主要终点是出院后死亡和因 HF 再次住院。中位年龄为 76[四分位距（IQR）：66，83]岁，732 例（66%）为男性。数据显示，自 2021 年以来，SGLT2 抑制剂的处方呈上升趋势。在中位随访 366 天（IQR：116，614）期间，458 例（41.3%）患者达到主要终点。Kaplan-Meier 分析显示，SGLT2i 组的复合事件发生率明显低于非 SGLT2i 组，无论总体情况（对数秩检验，P<0.001）还是左心室射血分数（LVEF）亚组情况：射血分数降低的 HF（HFREF）（n=413）、射血分数轻度降低的 HF（HFmrEF）（n=226）和射血分数保留的 HF（HFpEF）（n=466）（对数秩检验；P=0.044，P=0.013 和 P=0.001）。此外，住院期间开始使用 SGLT2 抑制剂的患者复合事件发生率明显低于未使用 SGLT2 抑制剂的患者（对数秩检验，P<0.001）。这种关联在 LVEF 亚组中也有显著意义（P=0.005，P=0.032 和 P=0.004）。
ADHF 患者住院期间开具和开始使用 SGLT2 抑制剂与改善出院后结局相关，与 LVEF 无关。
