Abstract
Background: Antineoplastic therapies can be cardiotoxic and increase the risk of cardiomyopathy and heart failure (HF). SGLT2i are shown to be efficaceous in patients across the spectrums of HF regardless of ejection fraction and presence of type 2 diabetes. However, the impact of these agents on outcomes in patients with antineoplastic therapy associated cardiomyopathy and HF has not been well established. Methods: A retrospective cohort analysis was performed on de-identified, aggregate patient data from the TriNetX research network. Patients ≥18 years of age with a history of exposure to potentially cardiotoxic antineoplastic therapy between Jan 1, 2013 and Apr 30, 2020 who subsequently developed cardiomyopathy or HF and treated with guideline directed medical therapy (GDMT) were identified. Patients with ischemic heart disease were excluded. Patients were divided into two groups based on SGLT2i use. Propensity score matching was performed to match the baseline characteristics. Odds ratio and log-rank test were used to compare the outcomes over a 2-year follow-up period. Results: In well matched cohorts (640 patients in each cohort with antineoplastic therapy associated cardiomyopathy/HF; mean age 67.6 years, women 41.6%, White 68%), patients on SGLT2i in addition to conventional GDMT faced lower risk of acute HF exacerbation (85 vs 154, OR 0.48, 95% CI: 0.36 - 0.65, p<0.001) and all-cause mortality (73 vs 194, OR 0.30, 95% CI: 0.22 - 0.40, p=0.001). Secondary outcomes of all-cause hospitalization or ER visit (OR 0.479, 95% CI: 0.383-0.599, p<0.001), atrial fibrillation/flutter (OR 0.397, 95% CI: 0.213-0.737, p=0.003), acute kidney injury (OR 0.486, 95% CI: 0.382-0.619, p<0.001), and renal replacement therapy (OR 0.398, 95% CI: 0.189-0.839, p=0.012) were also less frequent in patients on SGLT2i. Conclusions: SGLT2i use is associated with lower risk of clinical events in patients with antineoplastic therapy associated cardiomyopathy or HF.
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