SGLT2i Use Linked to Reduced Mortality in Comorbid HF, Diabetes

Heart failure, dilated cardiomyopathy
Heart failure, dilated cardiomyopathy
SGLT2i use was linked to reduced mortality and morbidity in a real-world cohort of patients with heart failure and diabetes.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use was associated with reduced mortality and morbidity among patients with type 2 diabetes (T2D) and heart failure (HF). These findings, reported from a cohort study, were published in the European Journal of Heart Failure.

This study analyzed data of patients (N=6805) with T2D and HF included in the Swedish Heart Failure Registry collected between 2016 and 2018. Patient characteristics, clinical outcomes, and prescribed therapies were assessed.

Patients were aged median 76.0 (interquartile range [IQR], 69.0-82.0) years, 32.1% were women, 48.0% had HF with reduced ejection fraction (EF), 27.9% had HF with preserved EF, and 24.1% had HF with mildly reduced EF.

SGLT2i was prescribed to 5.5% of patients, of whom 55.9% were new users, indicating an increase of use in recent years.

Recipients of SGLT2i were younger (P <.001), were more likely to be male (P <.001), and had higher BMI (P =.006). Compared with nonrecipients of SGLT1i, more were treated as an outpatient (P <.001), more were referred to an HF clinic (P <.001), and more had HF with reduced EF (P =.017).

To correct for these baseline differences, the investigators applied a propensity matching procedure, such that the SGLT2i users (n=361) and nonusers (n=1083) did not differ significantly for baseline characteristics or most clinical variables.

During the 1.5-year follow-up, rates of cardiovascular death or first HF hospitalization were decreased among the SGLT2i cohort (P =.023).

Among the matched cohort, SGLT2i was associated with decreased risk for first HF hospitalization (hazard ratio [HR], 0.70; 95% CI, 0.50-0.98; P =.037), first cardiovascular hospitalization (HR, 0.72; 95% CI, 0.56-0.94; P =.015), all-cause mortality (HR, 0.55; 95% CI, 0.34-0.88; P =.014), and cardiovascular death (HR, 0.53; 95% CI, 0.29-0.97; P =.039).

This study may have been limited by the fact that overall estimates of mortality were lower than in most studies, indicating this Swedish HF population may have decreased risk for overall mortality compared with similar, non-Swedish populations, and, therefore, results may not be generalizable.

These data suggest that patients with HF and T2D benefited from SGLT2i use regardless of HF subtype.

Furthermore, these findings “highlight the need of implementing the use of SGLT2i in T2DM patients with HF regardless of [ejection fraction]”, the study authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Beecher PM, Schrage B, Ferrannini G, et al. Use of sodium-glucose co-transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus: Data from the Swedish Heart Failure Registry. Eur J Heart Fail. Published online February 18, 2021. doi:10.1002/ejhf.2131