SGLT2 inhibition benefit in HFrEF confirmed in meta-analysis

  • Lancet

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • For heart failure with reduced ejection fraction (HFrEF), the sodium-glucose co-transporter-2 (SGLT2) inhibitors empagliflozin and dapagliflozin are consistently linked to improved outcomes in this meta-analysis.
  • These authors assessed data from DAPA-HF and EMPEROR-Reduced, evaluating mortality, heart failure hospitalization (HHF), and renal outcomes in different subgroups.

Why this matters

  • These authors say that the findings support use of these SGLT2 inhibitors to improve event-free survival in patients with HFrEF.

Key results

  • In the combined patient population from the 2 trials (n=8474), pooled HRs (95% CIs) with treatment:
    • 0.87 (0.77-0.98) for all-cause death;
    • 0.86 (0.76-0.98) for cardiovascular death;
    • 0.74 (0.68-0.82) for combined cardiovascular death/first HHF;
    • 0.75 (0.68-0.84) for combined recurrent HHF or cardiovascular death.
    • 0.62 (0.43-0.90) for the composite renal endpoint.
  • Benefit was consistent across subgroups (e.g., sex, diabetes, baseline estimated glomerular filtration rate).
  • Potential interactions of treatment seen with heart failure functional class (P for interaction=.0087), white race (P for interaction=.0063), and European region (P for interaction=.037).

Study design

  • Prespecified meta-analysis of the 2 trials.
  • Funding: Boehringer Ingelheim.

Limitations

  • Analysis did not access all individual patient data.
  • No correction for multiple testing in subgroup analyses, so results should be considered hypothesis-generating.