PO-455617-21 SGLT2 INHIBITORS REDUCE RISK OF SUDDEN CARDIAC DEATH IN PATIENTS WITH HEART FAILURE: A META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Abstract

Multiple randomized controlled trials have demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) decrease the composite endpoint of cardiovascular death or heart failure hospitalizations in heart failure patients. But it is uncertain whether SGLT2i impact the risk of sudden cardiac death in these patients with heart failure. We conducted a meta-analysis of SGLT2i randomized controlled trials to determine the impact of SGLT2i therapy on arrhythmic outcomes in patients with heart failure receiving optimal medical therapy. A comprehensive search was performed to identify relevant data published prior to August 28, 2022. Randomized controlled trials were included if: 1) all patients had clinical heart failure 2) SGLT2i and placebo were compared 3) all patients received conventional medical therapy and 4) there were the reported outcomes of interest (SCD, ventricular arrhythmias, atrial arrhythmias). SCD was reported in seven of the eleven trials meeting selection criteria. Taken together, 10,796 patients received SGLT2i and 10,796 received placebo. SGLT2i therapy was associated with a significant reduction in the risk of SCD (RR 0.68; 95% CI 0.48–0.95; p = 0.03) with minimal heterogeneity between studies (I2 = 0%). Without the benefit of dedicated rhythm monitoring, there were no significant differences in the incidence of sustained ventricular arrhythmias not associated with SCD (RR 1.03; 95% CI, 0.83–1.29; p = 0.77; I2 = 0%) or atrial arrhythmias (RR 0.91; 95% CI, 0.77–1.09; p = 0.31; I2 = 29%) between patients receiving an SGLT2i vs placebo. SGLT2i therapy is associated with a reduced risk of SCD in patients with heart failure receiving contemporary medical therapy.