Naslov
The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure: a meta-analysis of pivotal randomized controlled trials including 17,911 patients

Autori
Kumrić, Marko ; Božić, Joško ; Berntsen, Julia ; Urlić, Hrvoje ; Plosnić Todorić Marija Rafaela ; Glavaš, Duška ; Mirić, Dino ; Mustapić, Ivona ; Borovac, Josip Anđelo

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, znanstveni

Skup
Heart Failure Congress & World Congress on Acute Heart Failure 2023

Mjesto i datum
Prag, Češka Republika, 20.05.2023. - 23.05.2023

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
heart failure ; sudden cardiac death ; scd ; empagliflozin ; dapagliflozin ; SGLT2 inhibitors ; pharmacotherapy ; HFrEF ; HFpEF

Sažetak
Background: A body of data confirmed survival and hospitalization benefit regarding the use of SGLT2 inhibitors (SGLT2is) in patients with heart failure (HF) across the spectrum of ejection fractions. However, their potential effect on the prevention of sudden cardiac death (SCD) is not sufficiently explored. Purpose: This study was designed to determine crude rates and the relative risk of SCD in patients with HF with respect to treatment with SGLT2i (dapagliflozin or empagliflozin, each 10 mg once daily) or placebo. Methods: By thorough search of MEDLINE and EMBASE electronic databases and application of prespecified exclusion criteria, we identified 66 potential studies. A total of 5 randomized controlled trials (RCTs) examining the use of SGLT2is in HF, conducted in the period from 2019 to 2022, were included in the meta-analysis. This included pivotal trials such as DAPA-HF, DECLARE-TIMI 58, DEFINE- HF, EMPEROR-Preserved, and DELIVER. The main outcome measure was the risk of SCD events among HF patients, for which a risk ratio (RR) and respective 95% confidence intervals (95% CI) were reported. Meta-analysis was performed by utilizing the Mantel- Haenszel method with the fixed-effects model. The heterogeneity across included trials was assessed by using the I2 test. P-values <0.05 were considered statistically significant. Results: A total of 17, 911 patients with HF were included in the final analysis. Out of those, 8940 patients were randomized to SGLT2i while 8971 were randomized to placebo. All included trials reported the number of SCD events that occurred during the whole course of the respective trial and this was disclosed either in the main manuscript or in the supplementary documents. The average follow- up period was 25 months. SCD events occurred in 156 (1.74%) patients that received SGLT2i, and in 197 (2.20%) patients that received a placebo. As shown in Figure 1, the use of SGLT2is was associated with a significantly reduced risk of SCD compared to placebo (RR 0.80, 95% CI 0.65–0.98 ; P=0.004) among patients with heart failure. Furthermore, no significant heterogeneity was detected across included trials (I2=0%, P=0.880). Conclusion: The results of the present meta-analysis suggest that SGLT2i use is associated with a 20% relative risk reduction of SCD in comparison to the placebo, in a wide population of patients with HF regardless of ejection fraction. Future well-designed, adequately powered RCTs for this particular outcome are needed to confirm these observations.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
Official congress of the Heart Failure Association (HFA) of the
European Society of Cardiology (ESC)

POVEZANOST RADA