Importance of sodium-glucose cotransporter 2 inhibitor use in diabetic patients with acute heart failure

• Published in: Therapeutic advances in cardiovascular disease Vol. 13; p. 1753944719894509
• Main Authors: Kambara, Takahiro, Shibata, Rei, Osanai, Hiroyuki, Nakashima, Yoshihito, Asano, Hiroshi, Murohara, Toyoaki, Ajioka, Masayoshi
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 2019; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Acute Disease; Acute Kidney Injury - epidemiology; Acute Kidney Injury - prevention & control; Aged; Aged, 80 and over; Biomarkers - blood; Blood Glucose - drug effects; Blood Glucose - metabolism; Comorbidity; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diuretics; Female; Glycated Hemoglobin A - metabolism; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart Failure - physiopathology; Humans; Japan - epidemiology; Male; Middle Aged; Original Research; Patient Admission; Progression-Free Survival; Recovery of Function; Retrospective Studies; Risk Factors; Sodium Potassium Chloride Symporter Inhibitors - administration & dosage; Sodium Potassium Chloride Symporter Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - administration & dosage; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Time Factors; Japan; heart failure; acute kidney injury; diabetes mellitus; SGLT2 inhibitor
• ISSN: 1753-9447; 1753-9455
• DOI: 10.1177/1753944719894509

Background: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. Methods: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). Results: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). Conclusions: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.