A Systematic Review and Meta-analysis of Randomized Placebo-controlled Trials 1 Year after Starting Sodium-glucose Transporter-2 Inhibitors in Heart Failure Patients with Reduced Ventricular Ejection Fraction

Arga Setyo Adji; Atiyatum Billah; Aufa Baraja; Assya Amrilia Permata Putri; Firman Suryadi Rahman

doi:10.3889/oamjms.2022.8017

Authors

Arga Setyo Adji Faculty of Medicine https://orcid.org/0000-0002-0188-0500
Atiyatum Billah Faculty of Medicine, Universitas Hang Tuah Surabaya, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-3436-9004
Aufa Baraja Faculty of Medicine, Universitas Hang Tuah Surabaya, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-6491-5109
Assya Amrilia Permata Putri Faculty of Medicine, Universitas Hang Tuah Surabaya, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-7059-7303
Firman Suryadi Rahman Department of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia https://orcid.org/0000-0002-1245-4400

DOI:

https://doi.org/10.3889/oamjms.2022.8017

Keywords:

Sodium-glucose transporter-2 inhibitors, Heart failure, Reduced ventricular ejection fraction

Abstract

Introduction: The Sodium-Glucose Cotransporter-2 Inhibitor (SGLT-2 inhibitor) is a diabetic medication. Recently, there has been enough evidence of SGLT-2 inhibitors in type 2 diabetes mellitus, driving in an abatement in cardiovascular breakdown hospitalization. To explore SGLT-2 inhibitor in cardiovascular breakdown with lower discharge portion, we led an orderly survey and meta-examination. Strategies: We played out a methodical writing search from various electronic databases. We used keywords:” SGLT-2 inhibitor '' and “Heart Failure.” Inclusion criteria are randomized placebo-controlled trial, one-year follow-up and ejection fraction 40% or less. Composite endpoint is cardiovascular mortality with hospitalization of heart failure. Individual outcomes include all-cause mortality, cardiovascular passing, and cardiovascular breakdown hospitalization. For low heterogeneity scores, results are introduced utilizing a danger proportion (RR) with a 95 percent certainty stretch and statistical analysis using a fixed-effect model.

Results: Total of two randomized control trial was selected (DAPA-HF [Dapagliflozin] and EMPEROR-Reduced [Empagliflozin]) with 8,474 patients pooled within our analysis. The results of the composite outcome compared SGLT-2 inhibitor with placebo had significant decrease in the composite of cardiovascular passing with hospitalization of cardiovascular breakdown (RR=0.78 [95% CI, 0.71–0.84], p<0.00001; I²=0%). Result of individual outcome showed significant reduction of all-cause mortality (RR=0.88 [95% CI, 0.79 – 0.98], p=0.03; I²=1%), cardiovascular mortality (RR=0.87 [95% CI, 0.77 – 0.99], p=0.03; I²=0%) and hospitalization of heart failure (RR=0.72 [95% CI, 0.65–0.81], p<0.00001; I²=0%). Conclusion: Within one year of treatment with an SGLT-2 inhibitor, the composite of cardiovascular passing with cardiovascular breakdown hospitalization, all-cause mortality, cardiovascular mortality, and cardiovascular breakdown hospitalization was significantly reduced.

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