Clinical Question

Is treatment with sodium-glucose cotransporter-2 (SGLT-2) inhibitors effective in decreasing hospitalization for patients with heart failure, even those without diabetes mellitus?

Bottom Line

In patients with heart failure, even in those without diabetes, adding an SGLT-2 inhibitor to treatment will have a modest effect on decreasing the likelihood of hospitalization for heart failure. In a previous meta-analysis with fewer studies overall, mortality risk was not reduced, although cardiovascular mortality was slightly decreased. Several guideline development groups have added SGLT-2 inhibitors to their treatment algorithms. (Level of Evidence = 1a)

Synopsis

The researchers followed PRISMA guidelines for conducting and reporting the analysis. They searched four databases, including the Cochrane Library, as well as reference lists and other systematic reviews, and they polled experts. They identified eight randomized controlled trials, published in English, enrolling a total of 15,022 patients with heart failure who were followed up for at least six months. Most of the trials were at low risk of bias, and heterogeneity among study results was very low. Adding SGLT-2 inhibitor treatment to existing therapy reduces the risk of hospitalization over the first six months by approximately one-third (i.e., 41 to 78 fewer hospitalizations per 1,000 people treated). All-cause mortality was not affected by treatment, but cardiovascular mortality was decreased with treatment (i.e., 2 to 41 fewer deaths per 1,000 patients treated over one year). There was no difference in outcomes for patients with or without diabetes or preserved or reduced ejection fraction. The effect of treatment was greater in the first year and in patients with a poorer prognosis. The analysis did not attempt to differentiate effectiveness among the SGLT-2 inhibitor options.