Real-World Effectiveness of SGLT2 Inhibitors Across Heart Failure Phenotypes: A Meta-Analysis
Abstract
Background: Sodium-glucose co-transporter-2 (SGLT2) inhibitors have demonstrated significant benefits in heart failure (HF) patients in randomised controlled trials (RCTs). However, real-world evidence (RWE) is crucial to confirm their efficacy in broader, unselected patient populations. This meta-analysis is aimed at synthesising real-world data on SGLT2 inhibitors in HF across various ejection fraction phenotypes.
Methods: We conducted a systematic review and meta-analysis of real-world observational studies on SGLT2 inhibitor use in HF patients. Comprehensive searches were performed across PubMed/MEDLINE, Embase, Web of Science, and Scopus. Data were pooled using random-effects models, assessing heterogeneity and bias and performing subgroup analyses. The review followed PRISMA guidelines and was PROSPERO-registered (CRD420261356715).
Results: Our search yielded over 4000 unique articles, with 21 observational studies (encompassing nearly 4.8 million HF patients from 17 countries) included in the quantitative meta-analysis. SGLT2 inhibitors consistently reduced HF hospitalisation rates in real-world use (pooled HR 0.65, 95% CI 0.59-0.72). This included a significant reduction in those with cardiovascular disease (HR 0.78, 95% CI 0.68-0.89) and without cardiovascular disease (HR 0.53, 95% CI 0.39-0.71). The absolute risk reduction for hospitalisation for HF in people with a history of CVD (ARR 1.17, 95% CI 0.78-1.55) was significantly greater than for those without CVD…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8 participants or records.
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