Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF.
Methods and results: We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55-0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29-0.67) and HF hospitalization (HR 0.77, 95% CI 0.59-0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38-0.66, P < 0.001).
Conclusion: Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.
Keywords: Atrial fibrillation; Clinical outcome; Heart failure; Sodium–glucose cotransporter 2 inhibitors; Type 2 diabetes mellitus.
In this multi-centre, registry-based analysis, the new use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in patients with atrial fibrillation and type 2 diabetes mellitus was associated with lower all-cause mortality or hospitalization due to heart failure (HF) events. All-cause mortality, HF hospitalization, ischaemic stroke, and composite renal outcomes, defined as >50% decline in renal function or new initiation of dialysis occurred significantly less in the SGLT2i new users, compared with the propensity score-matched controls. The difference in outcomes between the SGLT2i group and control group was more pronounced in patients with higher HbA1c at baseline and prior HF.
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