Cherbi Miloud, Lairez Olivier, Baudry Guillaume, Gautier Paul, Roubille François, Delmas Clément
Intensive Cardiac Care Unit Université Paul Sabatier - Toulouse III Toulouse France.
Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux Nancy France.
J Am Heart Assoc. 2025 Apr 15;14(8):e039105. doi: 10.1161/JAHA.124.039105. Epub 2025 Apr 7.
Observational studies and small randomized controlled trials have suggested the benefits of early introduction of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in acute heart failure (AHF). However, current evidence on their efficacy and safety in this clinical setting remains limited.
We performed a systematic review and meta-analysis to assess efficacy/safety of early use of SGLT2is in AHF. PUBMED/EMBASE/Cochrane were searched from inception to May 31, 2024, for randomized controlled trials evaluating outcomes of SGLT2i early initiation in patients with AHF. Efficacy outcomes were all-cause death and heart failure rehospitalizations. Safety outcomes included acute kidney injury, ketoacidosis, urinary tract infections, hypotension, and hypoglycemia. Early initiation was defined as performed before or shortly after discharge (within 3 days). A sensitivity analysis was conducted, including only patients with initiation before discharge.
Seven randomized controlled trials that enrolled 2320 patients were included. Early use of SGLT2is was associated with a significant reduction in all-cause death (odds ratio, 0.71 [95% CI, 0.55-0.92; 95% PI, 0.55-0.98]) and HF rehospitalizations (odds ratio, 0.73 [95% CI, 0.57-0.94; 95% PI, 0.58-0.93]), even after adjusting for follow-up duration. SGLT2i initiation before discharge yielded consistent results for efficacy outcomes. Safety outcomes could not be usefully determined because of a low events rate resulting in wide CIs. The impact of diabetic status remains basically unknown due to the small number of available randomized controlled trials investigating this population.
Early introduction of SGLT2is in AHF improves all-cause death and rehospitalization rates, can be performed before discharge, and should be offered to most patients with AHF.
观察性研究和小型随机对照试验表明，早期使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对急性心力衰竭（AHF）有益。然而，目前关于其在该临床环境中的疗效和安全性的证据仍然有限。
我们进行了一项系统评价和荟萃分析，以评估早期使用SGLT2i治疗AHF的疗效/安全性。检索了PUBMED/EMBASE/Cochrane数据库，时间范围从建库至2024年5月31日，以查找评估早期启动SGLT2i治疗AHF患者结局的随机对照试验。疗效结局为全因死亡和心力衰竭再住院。安全性结局包括急性肾损伤、酮症酸中毒、尿路感染、低血压和低血糖。早期启动定义为在出院前或出院后不久（3天内）进行。进行了敏感性分析，仅纳入出院前启动治疗的患者。
纳入了7项随机对照试验，共2320例患者。即使在调整随访时间后，早期使用SGLT2i仍与全因死亡（优势比，0.71[95%CI，0.55-0.92；95%PI，0.55-0.98]）和心力衰竭再住院（优势比，0.73[95%CI，0.57-0.94；95%PI，0.58-0.93]）的显著降低相关。出院前启动SGLT2i治疗在疗效结局方面产生了一致的结果。由于事件发生率低导致置信区间较宽，无法有效确定安全性结局。由于研究该人群的随机对照试验数量较少，糖尿病状态的影响基本未知。
在AHF中早期使用SGLT2i可改善全因死亡和再住院率，可在出院前进行，应提供给大多数AHF患者。
