Abstract
Abstract: SGLT2i have recently demonstrated efficacy in reducing acute CHF exacerbations, hospitalizations, and major adverse cardiac outcomes. Their efficacy in reducing symptom burden remains unclear. The purpose of this study is to quantify heart failure symptom burden improvement as measured by the Kansas City Cardiomyopathy Questionnaire. Methods: A systematic review of MEDLINE and the Clinical Trials Database using PRISMA guidelines was conducted using the search terms SGLT2 inhibitor and heart failure. Studies were included if they measured change from baseline values of KCCQ Total Symptom Score in treatment and control groups. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model using mean differences was utilized. Revman 5.3 was used to aggregate outcomes and statistics. Results: A total of 14 studies with 18,117 patients were included. The studies comprised of 10,996 patients with HFrEF and 7,121 patients had HFpEF. The aggregate score improvement was significant with a mean difference of 1.87 [1.54, 2.20] Test for overall effect: Z = 11.05 (P < 0.00001). Study heterogeneity was also significant (Heterogeneity: Tau 2 = 0.07; Chi 2 = 634.86, df = 13 (P < 0.00001); I 2 = 98%). A subgroup analysis of HFpEF only patients showed a significant improvement: 2.46 [0.75, 4.18] Test for overall effect: Z = 2.82 (P = 0.005). Conclusion: SGLT2i reduce symptom burden with a modest improvement that is statistically significant regardless of ejection fraction. However, long term results are needed to quantify clinically significant symptom reduction.
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