(44) Association Between Sodium-Glucose Co-Transporter 2 Inhibitors and Heart Failure Readmission Among Patients with Type 2 Diabetes

Publication Number: 718

Background: Sodium glucose co-transporter 2 inhibitors (SGLT2is) reduces the risk of hospitalization for heart failure (HF). However, the effect of SGLT2is on HF readmission among patients with type 2 diabetes hospitalized with HF remains uncertain; several clinical trials are ongoing to address this.

Objectives: To investigate the effectiveness of SGLT2is on the risk of HF readmission among patients with type 2 diabetes hospitalized with HF.

Methods: We conducted a cohort study using Korea's nationwide health insurance claims data. The study population was patients with type 2 diabetes newly hospitalized with HF between 1 Jan 2016 and 31 Dec 2019. SGLT2i users were patients prescribed SGLT2is during their hospitalization or at discharge, and non-users were those not prescribed SGLT2is during this period. Propensity score matching was done in a 1:1 ratio between SGLT2i users and non-users to balance potential confounders. Primary outcomes were the HF readmission and in-hospital mortality at 30 days after discharge. Exploratory outcomes were cardiorenal safety outcomes of myocardial infarction, stroke, and acute kidney injury. We used Cox regression models to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for the study outcomes associated with SGLT2i use versus non-use.

Results: Of 25,627 patients with type 2 diabetes newly hospitalized with HF, we identified 1067 patient-pairs of SGLT2i users and non-users after propensity score matching (mean age 69.1 years; 51.8% male). Among 166 events of HF readmissions within 30 days after discharge, 69 occurred in SGLT2i users and 97 in non-users, with its risk significantly lower among SGLT2i users versus non-users (HR 0.70, 95% CI 0.51 to 0.95). Meanwhile, the risk of 30-day in-hospital deaths was statistically non-significant between exposure groups (0.60, 0.22 to 1.65); 6 and 10 events occurred in SGLT2i users and in non-users, respectively. Findings from our exploratory analyses showed no increased risks for the cardiorenal safety outcomes associated with SGLT2is when compared with non-users.

Conclusions: These findings suggest that use of SGLT2is was associated with a reduced risk of HF readmission among patients with type 2 diabetes hospitalized with HF in routine practice.