Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure

Abstract

Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. This study aimed to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use is safe in patients hospitalized for acute HF and whether its use is associated with improved clinical outcomes. We conducted a single-center, retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into 2 matched groups based on inpatient SGLT2I use. The matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. A total of 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, whereas 9 (8.2%) were treated with empagliflozin. The mean age was 71 years, 37.7% were women, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. The length of stay was 10 days in the SGLT2I group and 11 days in the control group (p = 0.43). A total of 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio 0.15, 95% confidence interval [CI] 0.03 to 0.66, p = 0.012). A total of 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio 1.58, 95% CI 0.74 to 3.37, p = 0.239). In addition, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had an HF readmission within 30 days (hazard ratio 3.75, 95% CI 1.05 to 13.44, p = 0.042). Acute kidney injury (54.5% vs 18.2%, p <0.001) and hypotension (12.7% vs 2.7%, p = 0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, the rate of 30-day HF readmission increased.

Keywords: SGLT2; acute heart failure; dapagliflozin; empagliflozin; hospitalization; sodium-glucose co-transporter-2 inhibitor.