What effect do sodium-glucose co-transporter 2 (SGLT2) inhibitors have on heart failure in real-world clinical practice? A meta-analysis of observational studies

Aims:
Cardiovascular outcome trials with sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated efficacy in reducing risk for hospitalisation for heart failure in high cardiovascular risk groups. However, it is unclear whether these findings translate to the real-world type 2 diabetes population, and to those at lower risk of cardiovascular events.  

Methods:
We used a comprehensive search strategy to identify observational studies that explored the association between SGLT2 inhibitors and heart failure events in people with type 2 diabetes across four databases (PubMed, EMBASE, CINAHL, ISI Web of Science). The identified studies were independently screened by two reviewers using a two-stage screening process. Data were extracted from all eligible studies and those with comparable outcome data were pooled for meta-analysis using random effects models. Results were reported using hazard ratios (HR) with 95% confidence intervals (CI).

Results:
Searches identified 132 studies of which 15 studies met our eligibility criteria, and 14  of these had comparable data for meta-analysis. Compared with other glucose-lowering medications, SGLT2 inhibitors were associated with reduced risk of hospitalisation for heart failure (HR 0.68, 95% CI 0.64-0.72; p<0.0001). Results were broadly consistent across the studies (I2=49%), and the Egger’s test was not signficant, which suggested that there was no publication bias (p=0.43). Prespecified subgroup analysis of people without a history of cardiovascular disease showed a similar effect (HR 0.64, 95% CI 0.55-0.73; p<0.0001). 

Conclusions:
SGLT2 inhibitors reduce the risk of hospitalisation for heart failure in people with type 2 diabetes including those without cardiovascular disease.