Factors associated with early initiation of SGLT2 inhibitors in hospitalized heart failure patients
D Darabantiu, C Giurca, D Balta, I Groza, S Mercea, R M Christodorescu, A Pop MoldovanAbstract
Abstract
Premises and purpose: SGLT2 inhibitors represent a cornerstone therapy in patients with heart failure. Guidelines recommend early initiation of SGLT2 inhibitors in heart failure, irrespective of ejection fraction. The objective of this study was to assess the factors related to predischarge initiation of SGLT2 inhibitors in patients with hospitalized acute heart failure.
Material and methods
This retrospective cohort study recruited 220 patients (P) hospitalized for acute heart failure (objective evidence of pulmonary and/or systemic congestion, increased NT-proBNP, need for intravenous loop diuretic). Patients were divided into 2 groups with respect to in-hospital initiation of SGLT2 inhibitors: SGLT2i present at discharge - group 1 (n=131) and SGLT2i not present at discharge – group 2 (n=89). Baseline clinical characteristics, left ventricular ejection fraction, ECG and laboratory parameters, associated treatment at discharge were recorded and compared between the 2 groups. Statistics: data were expressed as mean ± standard deviation or percentages, comparisons between groups were done with Student’s unpaired t test, comparisons between categorical values were done with Fisher’s exact test.
Results
At admission patients in group 1 were younger (67±12 vs 72±13 years, p=0.007), more frequently male (93 P - 71% vs 55 P-61% - p=0.1) and with diabetes (64 P- 49% vs 27 P – 30% - p=0.007). Less patients in group 1 had de novo heart failure (60 P – 46% vs 59 P – 66%, p=0.003). There were no significant differences concerning heart failure etiology, atrial fibrillation and QRS duration. With regard to clinical characteristics, at admission there were no differences concerning systolic BP (140±35 vs 139±24 mmHg – p=0.9), diastolic BP (83±13 vs 82±13 mmHg – p=0.4) and heart rate (95±21 vs 97±26 b/min – p=0.4). Left ventricular ejection fraction was lower in group 1 (31 ± 10 vs 37± 12% - p=0.0001). Mean NT-proBNP was similar (11606±9171 vs 10281±7963 pg/ml – p= 0.2).In group 1 eGFR was higher at discharge (65±23 vs 57±24 ml/min/m2 – p=0.04), . Weight at admission was higher in group 1 (85±21 vs 78±20 kg, p=0.03), but at discharge there were no differences (78±19 vs 75±17 kg, p=0.2). As for heart failure therapy at discharge, group 1 patients received more often betablockers (124 P-94% vs 71 P-79%,p=0.0009) and MRA antagonists (114 P-87% vs 68 P-76%, p=0.04)
Conclusions
In patients with hospitalized acute heart failure, factors associated with the early initiation of SGLT2 inhibitors were younger age, male gender, previous heart failure diagnosis, diabetic status, better renal function and lower ejection fraction.