Efficacy of SGLT2 Inhibitors in Patients With Heart Failure and Mildly Reduced or Preserved Ejection Fraction: An Updated Systematic Review and Meta-Analysis.
Tingyu Wang, Tingfen Wang, Runfeng Zhang
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis pooled 18 randomized controlled trials involving 18 774 patients with heart failure and left ventricular ejection fraction > 40%. Compared with placebo or standard care, SGLT2 inhibitors reduced the odds of the primary composite cardiovascular endpoint (OR: 0.71; 95% CI: 0.66-0.75, P < 0.00001) and first hospitalization for heart failure (OR: 0.69; 95% CI 0.64-0.74; P < 0.00001). Cardiovascular and all-cause mortality reductions were not statistically significant. The analysis also reported improvements in quality of life and functional measures.
Key findings
- The primary composite cardiovascular endpoint was lower with SGLT2 inhibitors (OR: 0.71; 95% CI: 0.66-0.75, P < 0.00001).
- First hospitalization for heart failure was reduced (OR: 0.69; 95% CI 0.64-0.74; P < 0.00001).
- Cardiovascular death (HR: 0.92; 95% CI 0.84-1.00; P = 0.05) and all-cause mortality (OR: 0.92; 95% CI 0.84-1.02; P = 0.10) reductions did not reach statistical significance.
- SGLT2 inhibitors significantly improved KCCQ-total symptom score, 6-minute walk test distance, and E / e ' ratio.
Why it matters
For patients with HFmrEF or HFpEF, the pooled evidence indicates fewer heart-failure hospitalizations and a lower composite cardiovascular outcome with SGLT2 inhibitors, alongside reported gains in symptoms and functional measures. The mortality findings are less conclusive, so the results distinguish prevention of worsening heart failure from a demonstrated survival benefit.
What to keep in mind
The abstract does not report the magnitude of improvement in quality-of-life or functional measures, and mortality effects were not statistically significant.