Sodium Glucose Co-trasporter-2 Inhibitors Initiation In Patients With Advanced Heart Failure Supported With Left Ventricular Assist Device

Abstract

Background Sodium glucose co-transporter-2 inhibitors (SGLT2i) have been shown to significantly improve cardiovascular outcomes in patients with heart failure with reduced ejection fraction (HFrEF). The tolerability and effectiveness of SGLT2i in patients with stage D HF requiring durable left ventricular assist device (LVADs) implantations is not known. The aim of the study was to evaluate the safety and effectiveness of SGLT2i therapy in patients with LVAD. Methods This is a retrospective chart review of patients treated with a SGLT2i post-LVAD implantation at our institution. Results We identified nine patients implanted with LVAD from January 2018 to March 2021. Mean age of 54 years, initiated on SGLT2i (empagliflozin or dapagliflozin) post-LVAD implantation. 75% destination therapy. The majority of patients were African-American (75%) and male (67%). Eight patients remain on SGLT2i therapy with no reported hypotension, hypoglycemia or other intolerance. One patient's therapy was discontinued following an admission for acute kidney injury, like due to volume depletion. Serum creatinine and weight were unaltered for those still on therapy. The utilization of SGLT2i therapy resulted in a reduction of diuretic dose, average of 29 mg of furosemide (range 0-160mg reduction). And for patients with concurrent diabetes (86%), A1c was reduced by 0.8%. Conclusion SGLT2i appear safe and tolerated when used in stage D HFrEF patients post LVAD implantation. Larger clinical studies are needed to establish safety and efficacy of SGLT2i in patients with advanced heart failure requiring LVAD support. Sodium glucose co-transporter-2 inhibitors (SGLT2i) have been shown to significantly improve cardiovascular outcomes in patients with heart failure with reduced ejection fraction (HFrEF). The tolerability and effectiveness of SGLT2i in patients with stage D HF requiring durable left ventricular assist device (LVADs) implantations is not known. The aim of the study was to evaluate the safety and effectiveness of SGLT2i therapy in patients with LVAD. This is a retrospective chart review of patients treated with a SGLT2i post-LVAD implantation at our institution. We identified nine patients implanted with LVAD from January 2018 to March 2021. Mean age of 54 years, initiated on SGLT2i (empagliflozin or dapagliflozin) post-LVAD implantation. 75% destination therapy. The majority of patients were African-American (75%) and male (67%). Eight patients remain on SGLT2i therapy with no reported hypotension, hypoglycemia or other intolerance. One patient's therapy was discontinued following an admission for acute kidney injury, like due to volume depletion. Serum creatinine and weight were unaltered for those still on therapy. The utilization of SGLT2i therapy resulted in a reduction of diuretic dose, average of 29 mg of furosemide (range 0-160mg reduction). And for patients with concurrent diabetes (86%), A1c was reduced by 0.8%. SGLT2i appear safe and tolerated when used in stage D HFrEF patients post LVAD implantation. Larger clinical studies are needed to establish safety and efficacy of SGLT2i in patients with advanced heart failure requiring LVAD support.