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Canadian Journal of Cardiology

Association of Eligibility for a Sodium-Glucose Co-transporter 2 Inhibitor and Cardiovascular Events in Patients with Atrial Fibrillation

      Abstract

      Background

      Sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce heart failure (HF) in a broad range of populations, but they have not been studied specifically in patients with atrial fibrillation (AF). We aimed to examine the association between SGLT2i-eligibility and cardiovascular events in AF patients to evaluate the potential utility of SGLT2is for AF management.

      Methods

      We pooled data from two randomized controlled trials (RCT) of AF patients (RE-LY and ACTIVE-W). Among patients assigned to anticoagulation arms, those meeting the enrollment criteria from at least one of the phase 3 SGLT2i RCTs were classified as “SGLT2i-eligible” and the remainder as “SGLT2i-ineligible”. The primary outcome was the composite of HF hospitalization or cardiovascular death.

      Results

      A total of 21,484 AF patients (mean age: 71.2±8.8, 36.1% women, median CHA2DS2-VASc Score=3) were included. The proportion of AF patients eligible for an SGLT2i was 41.2%. SGLT2i-eligible patients had higher rates of cardiovascular death/hospitalization for HF (5.8 vs. 3.2/100 person-years, Plog-rank<0.001), cardiovascular death (3.9 vs. 1.5/100 person-years, Plog-rank<0.001), and hospitalization for HF (2.5 vs. 1.9/100 person-years, Plog-rank<0.001). The age- and sex-adjusted model showed that SGLT2i-eligible patients were at a higher risk of cardiovascular death/hospitalization for HF (HR 1.97, 95% CI 1.79-2.17; P<0.001), cardiovascular death (HR 2.75, 95% CI 2.41-3.13, P<0.001), and hospitalization for HF (HR 1.41, 95% CI 1.23-1.62, P<0.001) than ineligible patients.

      Conclusions

      Most patients with AF do not currently have an indication for SGLT2is, but still have a substantial risk of cardiovascular events. Future randomized trials should evaluate the efficacy of SGLT2is in AF patients.

      Graphical abstract

      Keywords

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