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Association between sodium-glucose cotransporter-2 inhibitors and incident atrial fibrillation/atrial flutter in heart failure patients with reduced ejection fraction: a meta-analysis of randomized controlled trials

Sfairopoulos, Dimitrios, Liu, Tong, Zhang, Nan, Tse, Gary, Bazoukis, George, Letsas, Konstantinos, Goudis, Christos, Milionis, Haralampos, Vrettos, Apostolos, Korantzopoulos, Panagiotis and others. (2023) Association between sodium-glucose cotransporter-2 inhibitors and incident atrial fibrillation/atrial flutter in heart failure patients with reduced ejection fraction: a meta-analysis of randomized controlled trials. Heart Failure Reviews, 28 (4). pp. 925-9236. ISSN 1382-4147. E-ISSN 1573-7322. (doi:10.1007/s10741-022-10281-3) (KAR id:99772)

Abstract

Atrial fibrillation (AF) and atrial flutter (AFL) are associated with adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF). We investigated the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on the incidence of AF and/or AFL in HFrEF patients. PubMed and linicalTrials.gov were systematically searched until March 2022 for randomized controlled trials (RCTs) that enrolled patients with HFrEF. A total of six RCTs with 9467 patients were included (N=4731 in the SGLT2i arms; N=4736 in the placebo arms). Compared to placebo, SGLT2i treatment was associated with a significant reduction in the risk of AF [relative risk (RR) 0.62, 95% confidence interval CI 0.44–0.86; P=0.005] and AF/AFL (RR 0.64, 95% CI 0.47–0.87; P=0.004). Subgroup analysis showed that empagliflozin use resulted in a significant reduction in the risk of AF (RR 0.55, 95% CI 0.34–0.89; P=0.01) and AF/AFL (RR 0.50, 95% CI 0.32–0.77; P=0.002). By contrast, dapagliflozin use was not associated with a significant reduction in the risk of AF (RR 0.69, 95% CI 0.43–1.11; P=0.12) or AF/AFL (RR 0.82, 95% CI 0.53–1.27; P=0.38). Additionally, a “shorter” duration (<1.5 years) of treatment with SGLT2i remained associated with a reduction in the risk of AF (<1.5 years; RR 0.58, 95% CI 0.36–0.91; P=0.02) and AF/AFL (<1.5 years; RR 0.52, 95% CI 0.34–0.80; P=0.003). In conclusion, SGLT2i therapy was associated with a signifcant reduction in the risk of AF and AF/AFL in patients with HFrEF. These results reinforce the value of using SGLT2i in this setting.

Item Type: Article
DOI/Identification number: 10.1007/s10741-022-10281-3
Uncontrolled keywords: SGLT2 inhibitors; heart failure; atrial fibrillation; atrial flutter
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Depositing User: Gary Tse
Date Deposited: 30 Jan 2023 12:49 UTC
Last Modified: 05 Nov 2024 13:05 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/99772 (The current URI for this page, for reference purposes)

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