Two meta-analyses support prioritizing use of SGLT2i in all HF patients

Two meta-analyses were performed including SGLT2i trials in HF patients: one including DELIVER and EMPEROR-Preserved and the other one of the 5 trials DELIVER, EMPEROR-Preserved, DAPA-HF, EMPEROR-Reduced and SOLOIST-WHF.

Presented at the ESC congress 2022 by: Muthiah Vaduganathan, MD – Boston, MA, USA

Introduction and methods

Two meta-analyses were performed with data of large outcome trials with SGLT2 inhibitors.

• The first was a prespecified (prior to unblinding of DELIVER) analysis. Individual participant-level data were used from DELIVER to harmonize endpoint definitions and subgroups.
• The second was an analysis of 5 trials with n>1000 based on systematic search. DELIVER, EMPEROR-Preserved, DAPA-HF, EMPEROR-Reduced and SOLOIST-WHF were included.

Main results

DELIVER and EMPEROR-Preserved meta-analysis

• A 20% reduction was observed in the primary endpoint of CV death or first hospitalization for HF with SGLT2 inhibitors compared to placebo (HR 0.80, 95%CI:0.73-0.87, P<0.001).
• There was a non-significant reduction in CV death in the SGLT2 inhibitor group (HR 0.88, 95%CI:0.77-1.00, P=0.052) and a significant reduction in hospitalization for HF (HR 0.74, 95%CI:0.57-0.83, P<0.001) Pheterogeneity >0.10 for all endpoints.
• The clinical benefit of SGLT2i was consistent across 13 subgroups and extended to patients with LVEF≥60%.

Meta-analysis of 5 large SGLT2i trials in HF

• There was a reduction in all outcomes with use of SGLT2 inhibitors compared with placebo. HRs for outcomes with SGLT2is were as follows: CV death or HF hospitalization 0.77 (95%CI:0.72-0.82); HF hospitalization 0.72 (95%CI:0.67-0.78); CV death 0.87 (95%CI:0.79-0.95); all-cause death 0.92 (95%CI:0.86-0.99).

Conclusion

The first prespecified meta-analysis of the 2 large trials DELIVER and EMPEROR-Preserved that enrolled patients with HFmrEF and HFpEF confirmed that SGLT2 inhibitors reduce CV death or HF hospitalization in this patient population.

Furthermore, a second comprehensive meta-analysis of 5 large outcomes trials with SGLT2 inhibitors with >20.000 participants with HF showed that SGLT2 inhibitors reduce CV outcomes and all-cause death across a broad range of patients with HF.

• Our reporting is based on the information provided at the ESC Congress -