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Timing of sodium–glucose cotransporter 2 inhibitor initiation and post-discharge outcomes in acute heart failure with diabetes: a population-based cohort study

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Aims — Results from randomized trials suggest benefit of sodium–glucose cotransporter 2 (SGLT2) inhibitor initiation in clinically stable acute heart failure. We aim to examine the real-world effectiveness of early versus delayed post-discharge SGLT2 inhibitor initiation in people with acute heart failure and type 2 diabetes.

Methods and results — Using linkable administrative databases in Ontario, Canada, individuals aged 66 years or older with type 2 diabetes who were discharged to the community from acute care hospitals for heart failure between 1 July 2016 and 31 March 2020 were included in this retrospective, population-based cohort study. The primary outcome was hospitalization for heart failure (HHF) or cardiovascular mortality as a composite. Follow-up started from discharge for maximum 1 year. We compared outcomes between post-discharge SGLT2 inhibitor initiation within 3 days, 4–90 days, or 91–180 days, versus delayed initiation for at least 180 days. The ‘clone-censor-weight’ approach with a target trial emulation framework was used to address time-related biases. There were 9641 eligible individuals. After cloning and artificial censoring, there were 38 564 clones, 12 439 person-years, and 7584 events. Compared to delayed initiation for at least 180 days, initiation within 3 days post-discharge was associated with a lower 1-year risk of HHF or cardiovascular mortality (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.45–0.83), while initiation 4–90 days (RR 0.83, 95% CI 0.72–0.93) or 91–180 days (RR 0.89, 95% CI 0.79–0.97) showed smaller risk reduction.

Conclusion — Real-world evidence supports early SGLT2 inhibitor initiation to reduce HHF or cardiovascular mortality in acute heart failure and type 2 diabetes.

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Citation

Wu CY, Shah BR, Sharma A, Sheng Y, Liu PP, Kopp A, Saskin R, Edwards JD, Swardfager W. Eur J Heart Fail. 2024; Sep 12 [Epub ahead of print].

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