Clinical outcomes in heart failure patients with and without atrial fibrillation receiving sodium-glucose cotransporter-2 inhibitor

Purpose: We report a retrospective analysis of a nationwide health database to study the association between sodium-glucose cotransporter-2 inhibitor (SGLT2I) use and the incidence of adverse clinical outcomes among heart failure (HF) patients with and without atrial fibrillation (AF) stratified by CHA2DS2–VASc score. Methods The outcome of this study was on the development of major adverse cardiac and cerebrovascular events (MACCE). By dividing the number of MACCE events by the total person-years, the incidence rate was calculated. The hazard ratio (HR) was estimated by the Cox proportional hazard model. 95% confidence interval (CI) was also presented to show the risk of MACCE for HF patients with and without AF taking SGLT2I. Results SGLT2I users had a lower risk of acute myocardial infraction (adjusted HR = 0.83; 95% CI = 0.74, 0.92), CV death (adjusted HR = 0.47; 95% CI = 0.42, 0.51) and all-cause death (adjusted HR = 0.39; 95% CI = 0.37, 0.41). Considering HF patients without AF and SGLT2I as the reference group, HF patients without AF but with SGLT2I had a reduced risk of adverse outcomes of 0.48 (95%CI = 0.45, 0.50) and HF patients with AF and SGLT2I had the decreased hazard ratio of 0.55 (95%CI = 0.50, 0.61). The adjusted HR of adverse outcomes for HF patients with CHA2DS2–VASc score less than 2 and SGLT2I with and without AF relative to HF patients without AF nor SGLT2I were 0.53 (95% CI = 0.41, 0.67) and 0.24 (95% CI = 0.12, 0.47), respectively. Compared to HF patients with no history of AF and SGLT2I, if patients additionally with SGLT2I and CHA2DS2–VASc score ≥ 2, the risk of the adverse outcome reduces to 0.48 (95% CI = 0.45, 0.50); if patients additionally with AF and CHA2DS2–VASc score ≥ 2, the risk of the adverse outcome reduces to 0.88 (95% CI = 0.80, 0.97); if patients additionally with AF, SGLT2I and CHA2DS2–VASc score ≥ 2, the risk of the adverse outcome reduces to 0.53 (95% CI = 0.47, 0.55). Conclusion We concluded that SGLT2I have a protective effect in HF patients, and the risk reduction is greater with a score of < 2 and without AF.