REAL-WORLD EVALUATION OF SGLT2 INHIBITORS IN HEART FAILURE WITH REDUCED EJECTION FRACTION: A RETROSPECTIVE COHORT STUDY
Author(s)
San Zeng Low, BSc, Winnie Foo, BSc, Louise Gek Huang Goh, PhD, Benjamin Ong Shao Kiat, BSc and MSc.
Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
OBJECTIVES: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are increasingly being recommended as add-on therapy to a combination of beta blocker (BB), an angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker or angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNI), and a mineralocorticoid receptor antagonist (MRA) to treat heart failure with reduced ejection fraction (HFrEF). This study compared real-world outcomes of BB + ACEi/ARB + MRA with and without SGLT2i (quadruple and triple therapy, respectively) in heart failure (HF) patients.
METHODS: This retrospective study utilised linked national health record databases and included adult patients with newly diagnosed HF between January 2016 to June 2024 receiving triple or quadruple therapy. Propensity score matching was employed to balance patient demographics, comorbidities and concomitant HF medications. Poisson regression was used to estimate incidence rate ratio (IRR) with 95% confidence interval (CIs) for primary composite outcome of cardiovascular (CV) death or HF hospitalisation, and secondary outcomes like all-cause death over a 1-year follow-up period.
RESULTS: The study included 7,013 patients, of whom approximately 70% were male, with a mean age of 66 years. Compared to the cohort on triple therapy, those on quadruple therapy had a higher prevalence of type 2 diabetes mellitus (67% vs 47%) but a lower prevalence of chronic kidney disease (60% vs 66%). After matching, 1,686 patients remained in each cohort with all covariates well-balanced. Quadruple therapy was associated with a 22% reduction in the 1-year composite outcome compared to triple therapy [IRR 0.78 (95% CI 0.67, 0.91)], while all-cause death was numerically lower but did not reach statistical significance [IRR 0.85 (95% CI 0.69, 1.05)].
CONCLUSIONS: Consistent with results from pivotal trials, this national real-world study confirmed that adding SGLT2i to triple therapy reduced the risk of CV death or HF hospitalisation, supporting the use of quadruple therapy as the optimal medical therapy for HFrEF.
METHODS: This retrospective study utilised linked national health record databases and included adult patients with newly diagnosed HF between January 2016 to June 2024 receiving triple or quadruple therapy. Propensity score matching was employed to balance patient demographics, comorbidities and concomitant HF medications. Poisson regression was used to estimate incidence rate ratio (IRR) with 95% confidence interval (CIs) for primary composite outcome of cardiovascular (CV) death or HF hospitalisation, and secondary outcomes like all-cause death over a 1-year follow-up period.
RESULTS: The study included 7,013 patients, of whom approximately 70% were male, with a mean age of 66 years. Compared to the cohort on triple therapy, those on quadruple therapy had a higher prevalence of type 2 diabetes mellitus (67% vs 47%) but a lower prevalence of chronic kidney disease (60% vs 66%). After matching, 1,686 patients remained in each cohort with all covariates well-balanced. Quadruple therapy was associated with a 22% reduction in the 1-year composite outcome compared to triple therapy [IRR 0.78 (95% CI 0.67, 0.91)], while all-cause death was numerically lower but did not reach statistical significance [IRR 0.85 (95% CI 0.69, 1.05)].
CONCLUSIONS: Consistent with results from pivotal trials, this national real-world study confirmed that adding SGLT2i to triple therapy reduced the risk of CV death or HF hospitalisation, supporting the use of quadruple therapy as the optimal medical therapy for HFrEF.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO101
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)