Impacto en los desenlaces intrahospitalarios con el inicio de un inhibidor del cotransportador de sodio-glucosa 2 (iSGLT2) en insuficiencia cardíaca aguda descompensada

Introduction: sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially used in the management of type 2 diabetes mellitus, have also demonstrated efficacy in symptomatic chronic heart failure (CHF) regardless of left ventricular ejection fraction (LVEF). Its early use in acute heart failure could have an impact on outcomes during the hospital stay. Objective: to assess the impact on in-hospital outcomes after early initiation of an SGLT2 inhibitor in patients with acute decompensated heart failure with reduced LVEF. Materials and method: it is a retrospective cohort taken from the MALEOS registry, in which patients with acute decompensated heart failure, with LVEF ≤ 40%, and without prior use of SGLT2i were selected and retrospectively classified according to whether or not they started SGLT2i during hospital admission. The final outcome was a composite of death, prolonged hospital stay (> 21 days), or requirement for inotropic use. COX regression analysis was performed and results were summarized using Kaplan-Meier survival curves. Results: a total of 173 patients were recruited, 53 were started on an SGLT2i. The use of SGLT2i reduced the composite outcome in a multivariate adjustment model (5/37), compared to those who did not receive it (48/136), HR 0.37 (95% CI 0.12-0.45, p 0.009). The result was less frequent in those who also received a Neprilysin receptor antagonist (ARNI) or a beta blocker. Conclusions: the in-hospital addition of an SGLT2i to treatment, in patients with acute decompensated heart failure with LVEF ≤ 40%, resulted in an improvement in primary outcomes, with a reduction in hospital stay and improved survival to discharge.