Effect of Sodium Glucose Co-transporter-2 Inhibitors in Heart Failure Patients

Aim: To study the management outcomes of heart failure therapy with SGLT2-inhibitors added to conventional therapy and to compare its effect in diabetic and non- diabetic heart f ailure patients.

Methods: This is a prospective observational study done at the Department of Cardiology of a tertiary care hospital from November 2020 to January 2022. The study included 100 heart failure patients who were divided into two groups based on administration of SGLT2 inhibitors. Group I consists of HF patients without SGLT2i and Group II: HF patients with SGLT2i. Subjective and objective parameters were recorded as well as the management patterns of the patients were recorded during the hospital stay and the outcomes (improvement in NYHA class, rehospitalisation and mortality) were assessed at follow up.

Results: Most of the patients included in the study belonged to NYHA class-III. In this study HFrEF was found to be more prevalent in both group I (71.4%) and group II (83.6%). There was a significant difference observed for ejection fraction both in Group-I (36.45 ± 0.6 vs 38.85 ± 0.75) and Group- II (34.3 ± 0..6 vs 39.2 ± 1.01) at admission and after follow up (P=0.001). In our study when the outcomes were compared between group-I and group-II, there was statistical significance observed for the improvement in NYHA class (54.2% vs 61.2%) and decrease in mortality (11.4% vs 4%) was also observed (P=0.01) at the end of 1 year follow up. The effect of SGLT2i on the primary outcome was consistent in patients regardless of the presence or absence of diabetes.

Conclusion: Our study highlights that when SGLT2 inhibitors are used for treating HF patients with or without diabetes, they can have a positive impact as they achieve outcomes like improvement in NYHA class, decreased rehospitalisation and reduction in mortality risk. The study also indicates improvement in Left ventricular ejection fraction in case of HFrEF patients. Furthermore, randomization trials are required to determine the efficacy of SGLT2 inhibitors in Indian population to ascertain its association with better outcomes and to further promote its use.