SGLT2 inhibitors decrease atrial fibrillation risk in patients with HFrEF

The use of SGLT2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF) was associated with lower rates of atrial fibrillation (AF) events and symptoms. This conclusion was based on a large retrospective cohort analysis.

Dr Joel Manuel Alejandro (University of Maryland, MD, USA) presented one of the abstracts featured in the Young Investigator Award Clinical Cardiology session [1]. New-onset AF is associated with a worse prognosis in patients with HF [2]. To date, secondary data from HF trials have shown unclear findings on the effect of SGLT2 inhibitors on AF. A systematic review found only a non-significant relative risk reduction of AF in patients with HF but with a stronger signal of efficacy in patients with HFrEF compared to those with HF with preserved ejection fraction [3]. To further explore the effects of SGLT2 inhibitors on AF risk in patients with HF, Dr Alejandro and his colleagues performed a retrospective cohort analysis. He explained that a randomised trial cannot be used for such an analysis since SGLT2 inhibitors have become a Class IA recommendation for patients with HF patients in most guidelines.

Using the multinational TriNetX Diamond Network, which consists of 200 million patients from 92 healthcare organisations, 2 cohorts of adults with HFrEF (n=54,025 each) were identified by propensity matching; 1 cohort consisted of SGLT2-inhibitor users, the other cohort did not. The study evaluated whether the use of SGLT2 inhibitors is associated with a reduction in the incidence of AF events and symptoms (tachycardia, palpitations, chest pain, syncope, fatigue, and weakness) in patients with HFrEF.

The mean age at HF diagnosis and the start of SGLT2 inhibitors was 66 years. Most (94%) participants had diabetes, which was the predominant reason for the prescription of SGLT2 inhibitors. The use of SGLT2 inhibitors in patients with HFrEF was found to be associated with lower risks of:

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  • AF events (OR 0.61; 95% CI 0.60–0.63);
  • AF symptoms (OR 0.52; 95% CI 0.50–0.53);
  • Major cardiovascular events (OR 0.47; 95% CI 0.46–0.48);
  • All-cause mortality (OR 0.44; 95% CI 0.42–0.45);
  • Myocardial infarction (OR 0.59; 95% CI 0.57–0.61);
  • Cerebral infarction (OR 0.61; 95% CI 0.59–0.64).

No increased incidence of diabetic ketoacidosis was observed (OR 1.00; 95% CI 0.87–1.15).

1. 
   
   1. Alejandro JM. Can SGLT2i use decrease the risk of atrial fibrillation in patients with heart failure with reduced ejection fraction: a retrospective cohort study. Young Investigator Award (YIA) Clinical Cardiology, Heart Failure 2024, 11–14 May, Lisbon, Portugal.
   2. Karnik AA, et al. Cardiol Clin. 2019;37:119–29.
   3. Ouyang X, et al. Cardiovasc Diabetol. 2023;22:124.

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Posted on 16 July 2024