Impact of sodium glucose co-transporter-2 inhibitors (SGLT-2i) use on hospitalization rate and length of stay in heart failure with reduced ejection fraction (HFrEF) patients: A retrospective analysis

Title : Impact of sodium glucose co-transporter-2 inhibitors (SGLT-2i) use on hospitalization rate and length of stay in heart failure with reduced ejection fraction (HFrEF) patients: A retrospective analysis

Abstract:

Introduction: Heart Failure (HF) affects more than 64 million people worldwide and has a significant effect on morbidity, mortality and healthcare costs. Sodium glucose co-transporter- 2 inhibitors (SGLT-2i) are known to reduce cardiovascular deaths and hospitalizations due to HF, regardless of the presence of diabetes mellitus (DM). In this study, we aim to identify the effects of SGLT-2i on HF hospitalizations and length of stay (LOS) in heart failure with reduced ejection fraction (HFrEF) patients.

Purpose: Hospitalizations for HF not only increase the risk of mortality but also pose a significant economic burden highlighting the importance of addressing this major public health concern. This study aims to compare the hospitalization rate and LOS in HFrEF patients on SGLT-2i vs HFrEF patients not on SGLT-2i.

Method: This is a single-center retrospective cohort study using Saint Michael’s Medical Center (SMMC) database. Adults (>18 years) with HFrEF (EF <50%) who were admitted to SMMC from January 2022 to December 2023 were included in this study. The patients were grouped into SGLT-2i taking and SGLT-2i not taking cohorts. The two groups were then compared for hospitalization rate and LOS. The limitation of our study is that only the SMMC database was used so outside hospitalizations are not accounted for.

Results: A total of 613 patients with acute decompensated heart failure with reduced ejection fraction (EF <50%) were included in the study, out of which 88 (14.4%) patients were receiving SGLT-2i at the time of admission. After adjusting for covariates, multivariable analysis showed that SGLT-2i use was associated with significantly lower hospitalizations (Odds Ratio [OR] = 0.24; 95% CI 0.14-0.40; p<0.001). Furthermore, SGLT-2i use was also associated with a significantly lower overall hospital length of stay (SGLT2i use: 0.0[0.0-3.7] days vs no SGLT-2i use: 3.0 [0.0-6.0] days; p<0.001). Both the associations were statistically significant.

Conclusion: SGLT-2i have shown dramatic benefits in cardiovascular outcomes. Clinical evidence supports their use in the HF population particularly HFrEF. Our study strongly supports the narrative and reveals a significantly lower rate of hospitalization and LOS in patients with EF < 50% that are taking SGLT-2i. Interestingly, only 14.4% of patients were on SGLT-2i which prompts a further dive into socioeconomic factors affecting their use.

Biography:

Dr. Ayushi Mohan, MD is a dedicated and compassionate physician currently pursuing her M.D. at New York Medical College. She trained at Kasturba Medical College, India for her medical school. Throughout her medical journey, Dr. Mohan has demonstrated a strong commitment to clinical excellence, research, and community service. Dr. Mohan is also highly involved in academic research, with multiple publications in top-tier journals such as Circulation, Journal of Cardiac Failure, and Journal of American College of Cardiology. Her research spans various cardiovascular topics, including myocardial infarction, heart failure therapies, and cardiac transplantation. She has been an active contributor to numerous peer-reviewed abstracts and has presented her findings at major medical conferences. A proactive volunteer, Dr. Mohan has contributed to several initiatives, including organizing educational campaigns on COVID-19, heart disease awareness, and basic life support training. She has also been recognized with awards for her volunteerism, including the "Corona Warrior" recognition from the Delhi Government for her work during the pandemic. Outside of medicine, Dr. Mohan is passionate about soccer, pickleball, poetry, playing the piano, and dancing. She is also an advocate for resident wellness, serving in various leadership roles to promote fitness, social engagement, and work-life balance within her residency program.