Title : Sodium-glucose cotransporter-2 inhibitors and health-related quality of life outcomes in all types of heart failure: a systematic review and meta-analysis
Abstract:
Introduction: Exercise intolerance in patients with heart failure leads to a lower quality of life. An increasing number of studies suggest that early initiation of guided-directed medical therapy (GDMT) leads to better outcomes. Sodium-glucose co-transporter-2 (SGLT-2) inhibitor is one of the cornerstones in heart failure treatment, but its effectiveness in improving quality of life remains uncertain. This meta-analysis aims to determine the outcomes of heart failure symptoms and cardiovascular death in all types of heart failure.
Methods: A comprehensive search of randomized controlled trials (RCT) was conducted examining the use of SGLT-2 inhibitors in all types of heart failure compared to placebo. Outcome measures for cardiovascular death and heart failure symptoms using the Kansas City Cardiomyopathy Questionnaire - Total Symptom Score (KCCQ-TSS) in the early phase of treatment and at 8 months were extracted and analyzed using random effects model on both dichotomous and generic inverse variance data types via Review Manager V5.4. The KCCQ-TSS ranges from 0 to 100, with higher scores indicating fewer symptoms and physical limitations associated with heart failure. The treatment effect was shown as a win ratio, in which a value greater than 1 indicates superiority.
Results: There were five studies included in the meta-analysis with 21,255 subjects analyzed. There were improvement in heart failure symptoms based on the KCCQ-TSS (HR 3.39 [95%CI: 2.95-3.89] I2 = 68%, p<0.00001) with substantial heterogeneity. The major source of heterogeneity identified was the interval when the KCCQ-TSS was performed, hence a sub-group analysis that specifically monitored patients on the 8th month of treatment was done which showed improvement in heart failure symptoms (HR 3.16 [95%CI: 2.98-3.36) I2=8%, p<0.00001) in SGLT-2 inhibitors compared to placebo group. There was also a higher rate of cardiovascular death in the placebo group which was statistically significant (RR 0.87 [95%CI: 0.80-0.95] I2=0, p=0.002).
Conclusion: The meta-analysis showed that initiation of SGLT-2 inhibitors resulted in marked improvement of heart failure symptoms which may potentially lead to improvement of patients’ quality of life. Furthermore, the study showed a decreased rate of cardiovascular death after initiation of SGLT-2 inhibitors. Therefore, SGLT-2 inhibitors in all types of heart failure are effective in promoting better quality of life and lowering incidence of cardiovascular
death.
Audeince Takeaway:
- The audience will learn the effectiveness in using SGLT-2 inhibitors with regards to the quality of life measured by the KCCQ-TSS.
- They will be able to determine the risk of rehospitalization in adding SGLT-2 inhibitors in the guided-directed medical therapy in patients with heart failure.
- They will be able to have an overview on the list of RCTs/trials available that studied the quality of life in patients with heart failure after the initiation of SGLT-2 medication and apply it clinically.
