Sglt2 inhibitors and outcomes in patients with diabetes after durable lvad implantation: a multicenter real-world cohort study
Abstract
The prognostic impact of sodium–glucose cotransporter-2 inhibitors (SGLT2i) in patients with diabetes who underwent durable left ventricular assist device (LVAD) implantation remains unclear.
To evaluate the association between SGLT2i therapy and cardiovascular and renal outcomes in LVAD recipients with diabetes during the chronic post-implantation phase.
Using the TriNetX Global Research Network, we identified adult patients with both diabetes and LVAD implantation (2014–2025). Exposure was defined as SGLT2i therapy (empagliflozin or dapagliflozin). A 90-day landmark analysis defined follow-up from 3 months to 1 year after LVAD implantation. The primary endpoint was major adverse cardiovascular events (MACE), defined as heart failure exacerbation (HFE) or all-cause mortality. Secondary outcomes were HFE, all-cause mortality, and major adverse kidney events (MAKE). Propensity score matching (1:1; caliper 0.1 SD) was applied before Cox proportional hazards analysis.
After matching, 714 patients were included in each group. Compared with nonusers, SGLT2i users had significantly lower risks of MACE (HR 0.617; 95% CI 0.511–0.746; p<0.0001), HFE (HR 0.643; 95% CI 0.526–0.786; p<0.0001), and all-cause mortality (HR 0.599; 95% CI 0.395–0.907; p=0.0145). The risk of MAKE was numerically lower but not significant (HR 0.776; 95% CI 0.38–1.584; p=0.485). Findings were consistent across prespecified subgroups, with no safety signal observed.
Among LVAD recipients with diabetes who…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 714 participants or records.
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