Evaluation of Inpatient Sodium-Glucose Co-Transporter-2 Inhibitor Use in Patients Hospitalized for Acute Heart Failure

Abstract

Hospitalization for acute heart failure (HF) represents an important opportunity for initiation and up-titration of guideline-directed medical therapy. The objective of our study was to determine whether sodium-glucose co-transporter-2 inhibitor (SGLT2I) use was safe in patients hospitalized for acute HF and whether its use was associated with improved clinical outcomes. We conducted a single-center retrospective cohort study of adults hospitalized for acute HF with any ejection fraction and separated them into two matched groups based on inpatient SGLT2I use. Matching yielded 110 patients in the SGLT2I group and 110 patients in the control group. 101 patients (91.8%) in the SGLT2I group were treated with dapagliflozin, while 9 (8.2%) were treated with empagliflozin. Mean age was 71 years, 37.7% were female, 70.9% were White, 22.7% were Black, and 64.1% were Hispanic or Latino. Length of stay was 10 days in the SGLT2I group and 11 days in the control group (p=0.43). 2 patients (1.8%) in the SGLT2I group and 13 patients (11.8%) in the control group died within 30 days of discharge (hazard ratio, 0.15; 95% CI, 0.03 to 0.66; p=0.012). 17 patients (15.5%) in the SGLT2I group and 11 patients (10.0%) in the control group had an all-cause readmission within 30 days (hazard ratio, 1.58; 95% CI, 0.74 to 3.37; p=0.239). Meanwhile, 11 patients (10.0%) in the SGLT2I group and 3 patients (2.7%) in the control group had a HF readmission within 30 days (hazard ratio, 3.75; 95% CI, 1.05 to 13.44; p=0.042). Acute kidney injury (54.5% vs. 18.2%; p<0.001) and hypotension (12.7% vs. 2.7%; p=0.005) occurred significantly more frequently in the control group. In conclusion, SGLT2I use in patients hospitalized for acute HF was associated with decreased 30-day all-cause mortality and lower rates of acute kidney injury and hypotension; however, 30-day HF readmission increased.