Benefit of sodium-glucose cotransporter-2 inhibitors on survival outcome is related to the type of heart failure: A meta-analysis

Aims: This meta-analysis aimed to evaluate the efficacy of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in different types of heart failure (HF). Methods: Randomized controlled trials (RCTs) comparing SGLT-2 inhibitors with placebo in patients with HF were searched in PubMed, the Cochrane Library database, and clinicaltrials.gov. A random-effects model was used for evidence synthesis. The primary endpoint was cardiac death. Results: We included 13 studies (12 RCTs). In patients with HF with preserved ejection fraction (HFpEF), SGLT-2 inhibitors reduced the composite endpoint of cardiac death or rehospitalization because of HF (HHF) (HR: 0.78, 95% CI: 0.70-0.87, I-2 = 0%, P < 0.001) and that of HHF (HR: 0.74; 95% CI: 0.64-0.85, I-2 = 0%, P < 0.001) but not that of cardiac death (HR: 1.01, 95% CI: 0.80-1.28, I-2 = 23.9%, P = 0.943). In patients with HF with reduced EF (HFrEF), SGLT-2 inhibitors reduced the composite endpoint of cardiac death or HHF (HR: 0.75, 95% CI: 0.69-0.82, I-2 = 0%, P < 0.001) and the individual endpoints of cardiac death (HR: 0.84, 95% CI: 0.75-0.95, I-2 = 0%, P = 0.007) and HHF (HR: 0.69, 95% CI: 0.62-0.77, I-2 = 0%, P < 0.001). Conclusions: SGLT-2 inhibitors reduced the risk of cardiac death in patients with HFrEF but not in those with HFpEF.