Sodium-glucose cotransporter-2 inhibitors protect against atrial fibrillation in patients with heart failure
Lili Zhou, Yuanyuan Yang, Weixing Han
Abstract
BACKGROUND: Heart failure (HF) often complicates atrial fibrillation (AF) and conversely, AF frequently complicates HF. Furthermore, the coexistence of both conditions significantly increases the risk of cardiovascular complications. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have been demonstrated to decrease hospitalizations for HF and reduce cardiovascular death. Therefore, this study evaluated the effects of SGLT-2 inhibitors on AF in patients with HF. METHODS: A total of 903 patients with HF were enrolled in this study. Basic patient data including demographic characteristics, medical history, cardiovascular medications, and results of biochemical tests were collated. Logistic regression analysis was performed to examine the association between SGLT-2 inhibitors and the risk of AF. The effects of SGLT-2 inhibitors on AF were further analyzed according to subgroups. RESULTS: Patients treated with SGLT-2 inhibitors experienced a lower prevalence of AF (8.4% vs. 12.1%, P<0.001) compared to patients without SGLT-2 treatment. Controlling for potential confounders revealed that SGLT-2 inhibitors decreased the risk of AF by 24% [odds ratio (OR): 0.76; 95% confidence interval (CI): 0.70-0.85; P<0.001]. The effect of SGLT-2 inhibitors on AF was consistent in patients aged < 65 years and patients aged ≥65 years (OR =0.82 and 95% CI: 0.71-0.88 vs. OR =0.84 and 95% CI: 0.77-0.92, respectively; P interaction =0.501). Similarly, neither gender, body mass index (BMI), estimated glomerular filtration rate (eGFR), nor the New York Heart Association (NYHA) classification affected the protective effect of SGLT-2 inhibitors. CONCLUSIONS: SGLT-2 inhibitors reduced the risk of AF in patients with HF, and the effect was consistent irrespective of age, gender, BMI, eGFR, and NYHA classification.