Incident arrhythmias, heart failure and cardiovascular outcomes with SGLT-2 inhibitor use in diabetic patients: Insights from a global federated electronic medical record database

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) use has been associated with improved outcomes in patients with prevalent heart failure (HF), regardless of whether or not they have diabetes. Purpose We aimed to investigate the impact of SGLT-2i use on the risk of incident HF and adverse cardiovascular outcomes in patients with diabetes. Methods All diabetic patients between January 2018 and December 2019 were identified from a federated electronic medical record database (TriNetX), and followed up for 2 years. A 1:1 propensity score matched (PSM) analysis was performed to balance SGLT-2i and non-SGLT-2i cohorts. The primary outcome was incident HF and secondary outcomes included all-cause mortality, cardiac arrest, ventricular tachycardia/fibrillation (VT/VF), incident atrial fibrillation (AF), ischaemic stroke, a composite of arterial and venous thrombotic events, and a composite of incident VT/VF and cardiac arrest. Results A total of 115,749 diabetic patients who were on SGLT-2i and 2,316,638 who were not on SGLT-2i were identified. After PSM, 115,749 patients remained in each group. In the PSM analysis, the risk of incident HF was significantly lower in patients who were on SGLT-2i, compared to patients who were not on SGLT-2i (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.65-0.70). SGLT-2i use was also associated with a significantly lower risk of all-cause mortality (HR 0.62, 95% CI 0.59-0.65), cardiac arrest (HR 0.62, 95% CI 0.55-0.69), incident AF (HR 0.78, 95% CI 0.75-0.81), ischaemic stroke (HR 0.93, 95% CI 0.88-0.96), composite arterial and venous thrombotic events (HR 0.93, 95% CI 0.90-0.95), and composite of incident VT/VF and cardiac arrest (HR 0.74, 95% CI 0.68-0.79), compared to SGLT-2i non-use. There were no significant differences between the two groups for VT/VF (HR 0.94, 95% CI 0.88-1.01). Conclusion SGLT-2i use was associated with a significant decrease in the risk of incident HF, all-cause mortality, cardiac arrest, incident AF, ischaemic stroke, thromboembolic events and VT/VF/cardiac arrest, when compared to the non-use of SGLT-2i.