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Review
. 2024 Dec 16;16(12):e75802.
doi: 10.7759/cureus.75802. eCollection 2024 Dec.

A Systematic Review and Meta-Analysis of Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors and Their Impact on the Management of Heart Failure

Nestor Lemos Ferreira  1 , Abiodun Bamidele Adelowo  2 , Zahid Khan  3   4   5   6
Affiliations
Review

A Systematic Review and Meta-Analysis of Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitors and Their Impact on the Management of Heart Failure

Nestor Lemos Ferreira et al. Cureus. .

Abstract

Heart failure (HF) is a life-threatening condition with severe incapacitating consequences. Many body organs and systems may be affected, which may also hinder the quality of life and finances at the individual and societal levels. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have also emerged as potentially useful drugs in the HF domain and other medical fields, in addition to their glucose-lowering effect. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the authors searched Google Scholar, PubMed, and Scopus websites for SGLT2i and SGLT2i-related terms and their impact on HF events, major adverse cardiovascular events (MACEs), renal composite outcomes, and improvement in the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, involving human adult populations. Two reviewers conducted the literature search, and disagreements were resolved through mutual consensus and input from a third reviewer. A literature search was conducted from 1st February to 20th February 2024. We included studies published after 2018 to focus only on the latest advancements. Randomized controlled trials, observational studies, or systematic reviews of these studies were included in our study. Of the 44 initial articles identified, only 14 met the inclusion and exclusion criteria. The outcomes revealed the superiority of SGLT2i therapeutics over placebo in all four domains mentioned above. A total of 234,509 patients from 11 papers with moderate heterogeneity (P = 0.07; I2 = 42%) evaluating the effect of SGLT2i in comparison to placebo on HF events were considered; of these, 128,477 patients received the intervention drug, and 106,032 individuals were assigned to the control group. The absolute numbers of HF events were 6845 and 8877, respectively. The study showed an overall benefit of SGLT2i in patients with heart failure due to their ability to major adverse cardiovascular events (MACE) in comparison to placebo (OR: 0.92; 95% CI: 0.89-0.96; P < 0.00001). This systematic review confirmed previous findings related to the use of SGLT2i as adjunctive therapy for HF and amelioration of KCCQ scores and as a protective agent against MACE and renal impairment progression.

Keywords: heart failure hospitalization; heart failure management programmes; heart failure prognosis; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; major adverse cardiovascular events (mace); preferred reporting items for systematic reviews and meta-analyses(prisma); remote monitoring of heart failure; sodium-glucose cotransporter-2 (sglt2) inhibitors; systolic heart failure.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram of literature search.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2. Forest plot of SGLT2i vs placebo related to HF events.
SGLT2i: sodium-glucose co-transporter 2 (SGLT-2) inhibitors, HF: heart failure. Note: This image is the author's own creation.
Figure 3
Figure 3. Funnel plot of SGLT2i studies related to HF events
SGLT2i: sodium-glucose co-transporter 2 (SGLT-2) inhibitors, HF: heart failure. Note: This image is the author's own creation.
Figure 4
Figure 4. Forest plot of SGLT2i vs placebo regarding MACE
SGLT2i: sodium-glucose co-transporter-2 inhibitors, MACE: major adverse cardiac events. Note: This image is the author's own creation.
Figure 5
Figure 5. Funnel plot of SGLT2i studies regarding MACE.
SGLT2i: sodium-glucose co-transporter-2 inhibitors, MACE: major adverse cardiac events. Note: This image is the author's own creation.
Figure 6
Figure 6. Forest plot of SGLT2i vs placebo concerning renal composite outcomes.
SGLT2i: sodium-glucose co-transporter 2 inhibitors. Note: This image is the author's own creation.
Figure 7
Figure 7. Funnel plot of SGLT2i research concerning renal composite outcomes.
SGLT2i: sodium-glucose co-transporter-2 inhibitors. Note: This image is the author's own creation.
Figure 8
Figure 8. Forest plot of SGLT2i vs placebo evaluating no improvement in KCCQ scores.
SGLT2i: sodium-glucose co-transporter-2 inhibitors, KCCQ: Kansas City Cardiomyopathy Questionnaire. Note: This image is the author's own creation.
Figure 9
Figure 9. Funnel plot of SGLT2i analysis evaluating no improvement in KCCQ scores.
SGLT2i: sodium-glucose co-transporter-2 inhibitors, KCCQ: Kansas City Cardiomyopathy Questionnaire. Note: This image is the author's own creation.
Figure 10
Figure 10. Risk of bias traffic light plot involving all the 14 selected studies in this systematic review.
Note: This image is the author's own creation.
Figure 11
Figure 11. Summary plot for risk of bias assessment for the included studies.
Note: This image is the author's own creation.
See this image and copyright information in PMC

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References

    1. The impact of case management on reducing readmission for patients diagnosed with heart failure and diabetes. McCants KM, Reid KB, Williams I, Miller DE, Rubin R, Dutton S. Prof Case Manage. 2019;24:177–193. - PubMed
    1. Pathophysiology of heart failure. Schwinger RHG. Cardiovasc Diagn Ther. 2021;11:263–276. - PMC - PubMed
    1. Burden, trends, and inequalities of heart failure globally, 1990 to 2019: a secondary analysis based on the global burden of disease 2019 study. Yan T, Zhu S, Yin X, et al. J Am Heart Assoc. 2023;12:0. - PMC - PubMed
    1. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. McDonagh TA, Metra M, Adamo M, et al. Eur Heart J. 2023;1:3627–3639. - PubMed
    1. Emerging concepts in heart failure management and treatment: focus on SGLT2 inhibitors in heart failure with preserved ejection fraction. De Lorenzi AB, Kaplinsky E, Zambrano MR, Chaume LT, Rosas JM. Drugs Context. 2023;12:2022–2027. - PMC - PubMed

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