The role of SGLT-2 inhibitors on health-related quality of life, exercise capacity, and volume depletion in patients with chronic heart failure: a meta-analysis of randomized controlled trials

Abstract

Background: Improving health-related quality of life (HRQoL) is essential in treating heart failure (HF). Evidence of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on HRQoL and exercise capacity needs to be systematically analyzed.

Aim: This meta-analysis aimed to summarize the effects of SGLT-2 inhibitors on HRQoL, exercise capacity, and volume depletion in patients with HF.

Method: Randomized controlled trials were searched from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. The intervention arm was the SGLT-2 inhibitor group, and the control group was the placebo group. HRQoL outcomes were the Kansas City Cardiomyopathy Questionnaires (KCCQ)-OSS (Overall Summary Score), KCCQ-CSS (Clinical Summary Score), and KCCQ-TSS (Total Symptom Score). Exercise capacity was a 6-min walk test distance (6MWTD). The last search was conducted in May 2022. Two researchers independently screened articles, extracted data, and evaluated the quality of included trials. The Cochrane risk-of-bias tool was used to assess the quality of each study. Random or fixed-effect models were used in statistical methods. I² statistics were used to assess heterogeneity.

Results: Eight studies (6,213 patients) were included. Compared to the placebo group, SGLT-2 inhibitors significantly improved HRQoL parameters of the KCCQ-CSS score [mean difference (MD) 5.17, 95% confidence interval (95% CI) 4.61-5.73, P < 0.01] and the KCCQ-OSS score (MD 4.00, 95% CI 3.44-4.56, P < 0.01). SGLT-2 inhibitors also significantly improved exercise capacity 6MWTD (MD 21.90, 95% CI 6.54-37.25, P = 0.005). There were no significant differences in KCCQ-TSS (MD 1.95, 95% CI - 1.10 to 5.01, P = 0.21) and volume depletion [odds ratio (OR) 1.15, 95% CI 0.94-1.42, P = 0.18] between the treatment and placebo groups.

Conclusion: SGLT-2 inhibitors could improve HRQoL and exercise capacity in patients with chronic HF. SGLT-2 inhibitors did not have an impact on volume depletion.

Keywords: Heart failure; Meta-analysis; Quality of life; SGLT-2 inhibitors; Volume depletion.