SGLT2 Inhibitor Therapy Could Curb Heart Failure Deaths

By David Duglas

May 15, 2020

NEW YORK (Reuters Health) — According to projections from a decision-analytical model, sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy could be of great benefit in certain patients with heart failure.

The findings show "that the addition of SGLT-2-inhibitor therapy to the standard medical regimen for patients with heart failure with reduced ejection fraction would be estimated to save 34,125 lives each year in the United States," Dr. Gregg C. Fonarow of the Ahmanson UCLA Cardiomyopathy Center, in Los Angeles, told Reuters Health by email.

SGLT-2 inhibitors were originally used in the management of type 2 diabetes, Dr. Fonarow and colleagues note in JAMA Cardiology. It has since been shown in the DAPA-HF trial that dapagliflozin can reduce heart failure (HF) events, cardiovascular death and all-cause mortality among patients with HF with reduced ejection fraction regardless of their diabetic status.

In the current study, the researchers estimate that of an estimated 3.1 million patients with HF and reduced ejection fraction in the U.S., more than 2 million (69%) may be candidates for therapy.

The team notes that the DAPA-HF trial studied 4,744 carefully selected patients for a median of 18.2 months and excluded many patients with HF seen in daily practice. Thus, they conducted a secondary analysis excluding patients on the basis of N-terminal-pro brain natriuretic peptide levels and other DAPA-HF trial entry criteria. This reduced the number of eligible patients by 25%, but still showed a potential decrease in annual deaths of more than 25,000.

"Beyond the mortality reduction," continued Dr. Fonarow, "this class of medication also significantly improves health status, quality of life, hospitalizations, and rehospitalization for patients with heart failure."

He concluded, "There is an critical need for implementation of randomized clinical trial evidence for SGLT2 inhibitors into routine clinical practice in a timely manner to achieve important population health benefits and to reduce the substantial mortality burden of heart failure."

The authors report no funding. Dr. Fonarow disclosed financial ties to manufacturers of SGLT2 inhibitors.

SOURCE: JAMA Cardiology, online May 5, 2020.