Predictors and Outcomes of SGLT2 Inhibitor Discontinuation in a Real-World Population after Hospitalization for Heart Failure
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Exclusion Criteria
2.3. Study Design and Data Collection
2.4. Study Endpoints
2.5. Statistical Analyses
3. Results
3.1. Follow-Up and Patient Characteristics
3.2. Causes of Primary Outcome
3.3. Prediction of Primary Outcome
3.4. Impact of SGLT2i Discontinuation on Clinical Outcomes
4. Discussion
4.1. Discontinuation of SGLT2i
4.2. Diabetes and SGLT2i Discontinuation
4.3. Hypoalbuminemia and SGLT2i Discontinuation
4.4. High Dose of Loop Diuretics and SGLT2i Discontinuation
4.5. Outcomes of SGLT2i Discontinuation
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 159) | Continuation (n = 140) | Discontinuation (n = 19) | p Value | |
---|---|---|---|---|
Age, years | 73 (64–81) | 72 (63–81) | 75 (69–83) | 0.281 |
Male, n (%) | 102 (64) | 93 (66) | 9 (47) | 0.104 |
Body weight, kg | 57.3 (50.0–66.8) | 57.3 (50.2–67.5) | 58.7 (47.0–64.1) | 0.547 |
Body mass index, kg/m2 | 22.6 (19.8–24.9) | 22.6 (19.9–24.9) | 22.2 (19.8–23.7) | 0.720 |
Systolic blood pressure, mmHg | 105 (96–117) | 104 (95–117) | 108 (98–118) | 0.227 |
Heart rate, beats per minutes | 70 (63–78) | 70 (63–78) | 71 (65–78) | 0.655 |
Diabetes mellitus, n (%) | 123 (77) | 105 (75) | 18 (95) | 0.054 |
Ischemic etiology, n (%) | 66 (42) | 58 (41) | 8 (42) | 0.955 |
Atrial fibrillation, n (%) | 45 (28) | 37 (26) | 8 (42) | 0.155 |
Implantable cardioverter-defibrillator, n (%) | 23 (13) | 22 (16) | 1 (5) | 0.224 |
Cardiac resynchronization therapy, n (%) | 16 (10) | 2 (11) | 14 (10) | 0.943 |
New York Heart Association class III–IV, n (%) | 36 (23) | 29 (21) | 7 (37) | 0.115 |
Left ventricular ejection fraction, % | 43 (33–55) | 43 (33–55) | 43 (31–60) | 0.744 |
Value of <40% (HFrEF), n (%) | 62 (39) | 54 (39) | 8 (42) | 0.767 |
Value of 40–49% (HFmrEF), n (%) | 42 (26) | 37 (26) | 5 (26) | 0.992 |
Value of ≥50% (HFpEF), n (%) | 55 (35) | 49 (35) | 6 (32) | 0.769 |
HbA1c, % | 6.7 (6.4–7.6) | 6.7 (6.3–7.6) | 6.9 (6.5–7.6) | 0.404 |
Fasting blood sugar, mg/dL | 110 (95–132) | 110 (95–130) | 121 (93–152) | 0.230 |
Hemoglobin, g/dL | 12.5 (11.2–13.9) | 12.6 (11.2–14.1) | 11.9 (10.6–13.5) | 0.089 |
Hematocrit, % | 37.8 (34.1–41.4) | 38.0 (34.2–41.6) | 35.5 (32.2–40.6) | 0.135 |
Serum albumin, g/dL | 3.6 (3.4–3.9) | 3.7 (3.4–4.0) | 3.4 (3.2–3.6) | 0.006 * |
Serum sodium, mEq/L | 138 (136–140) | 138 (137–140) | 136 (135–140) | 0.258 |
Serum potassium, mEq/L | 4.3 (4.1–4.6) | 4.3 (4.1–4.6) | 4.5 (3.9–4.8) | 0.641 |
eGFR, mL/minute/1.73 m2 | 50.5 (36.9–64.4) | 51.2 (36.9–66.6) | 41.2 (36.9–58.8) | 0.342 |
Uric acid, mg/dL | 5.7 (4.8–6.9) | 5.7 (4.8–7.0) | 6.0 (5.6–6.7) | 0.418 |
Plasma BNP, pg/mL | 142 (69–284) | 142 (69–269) | 182 (68–477) | 0.237 |
Heart failure therapies | ||||
Beta-blockers, n (%) | 142 (89) | 124 (89) | 18 (95) | 0.415 |
ACEI/ARB/ARNI, n (%) | 149 (94) | 130 (93) | 19 (100) | 0.229 |
Loop diuretics, n (%) | 102 (64) | 88 (63) | 14 (74) | 0.356 |
Dose of furosemide, mg/day | 10 (0–20) | 10 (0–20) | 20 (0–20) | 0.223 |
MRA, n (%) | 54 (34) | 44 (31) | 10 (53) | 0.067 |
Thiazides, n (%) | 3 (2) | 3 (2) | 0 (0) | 0.520 |
Anti-diabetic agents | ||||
Sulfonylureas, n (%) | 6 (4) | 6 (4) | 0 (0) | 0.358 |
DPP-4i, n (%) | 62 (39) | 53 (38) | 9 (47) | 0.425 |
Biguanides, n (%) | 22 (14) | 21 (15) | 1 (5) | 0.249 |
Insulin, n (%) | 13 (8) | 10 (7) | 3 (16) | 0.197 |
Sodium–glucose cotransporter 2 inhibitors | ||||
Canagliflozin, n (%) | 37 (23) | 32 (23) | 5 (26) | 0.738 |
Dapagliflozin, n (%) | 82 (52) | 75 (54) | 7 (37) | 0.171 |
Empagliflozin, n (%) | 40 (25) | 33 (24) | 7 (37) | 0.211 |
All Patients (n = 159) | ||||||
---|---|---|---|---|---|---|
Univariable Analysis | Multivariable Analysis | |||||
Variables | Odds Ratio | 95% CI | p Value | Odds Ratio | 95% CI | p Value |
Age, years | 1.03 | 0.98–1.08 | 0.224 | |||
Male, yes | 0.46 | 0.17–1.20 | 0.110 | |||
Body mass index, kg/m2 | 0.97 | 0.86–1.10 | 0.657 | |||
Systolic blood pressure, mmHg | 1.02 | 0.99–1.05 | 0.136 | |||
Heart rate, bpm | 1.01 | 0.97–1.06 | 0.578 | |||
Ischemic etiology, yes | 1.03 | 0.39–2.71 | 0.955 | |||
Atrial fibrillation, yes | 2.03 | 0.73–5.40 | 0.161 | |||
NYHA class III–IV, n (%) | 2.23 | 0.81–6.18 | 0.122 | |||
HFrEF, yes | 1.16 | 0.44–3.06 | 0.767 | |||
Diabetes mellitus, yes | 6.00 | 0.77–46.59 | 0.087 | |||
Fasting blood sugar, mg/dL | 1.01 | 1.00–1.02 | 0.219 | |||
Hematocrit, % | 0.93 | 0.85–1.03 | 0.157 | |||
Serum albumin, g/dL | 0.19 | 0.06–0.62 | 0.006 * | 0.23 | 0.07–0.76 | 0.016 * |
Serum sodium, mEq/L | 0.96 | 0.84–1.10 | 0.551 | |||
Serum potassium, mEq/L | 1.24 | 0.47–3.29 | 0.670 | |||
eGFR, mL/min/1.73 m2 | 0.99 | 0.97–1.02 | 0.605 | |||
Uric acid, mg/dL | 1.07 | 0.81–1.42 | 0.638 | |||
ln BNP | 1.41 | 0.85–2.33 | 0.187 | |||
Beta-blockers, yes | 2.32 | 0.29–18.59 | 0.427 | |||
ACEI/ARB/ARNI, yes | NA | NA | 0.993 | |||
Loop diuretics, yes | 1.66 | 0.56–4.86 | 0.360 | |||
Dose of furosemide, mg/day | 1.03 | 1.01–1.05 | 0.013 * | 1.02 | 1.00–1.05 | 0.046 * |
MRA, yes | 2.42 | 0.92–6.39 | 0.073 | |||
Thiazides, yes | NA | NA | 0.991 | |||
Sulfonylureas, yes | NA | NA | 0.992 | |||
DPP-4i, yes | 1.48 | 0.56–3.87 | 0.427 | |||
Biguanides, yes | 0.32 | 0.04–2.49 | 0.273 | |||
Insulin, yes | 2.44 | 0.61–9.79 | 0.209 |
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Nakagaito, M.; Imamura, T.; Ushijima, R.; Nakamura, M.; Kinugawa, K. Predictors and Outcomes of SGLT2 Inhibitor Discontinuation in a Real-World Population after Hospitalization for Heart Failure. Biomedicines 2023, 11, 876. https://doi.org/10.3390/biomedicines11030876
Nakagaito M, Imamura T, Ushijima R, Nakamura M, Kinugawa K. Predictors and Outcomes of SGLT2 Inhibitor Discontinuation in a Real-World Population after Hospitalization for Heart Failure. Biomedicines. 2023; 11(3):876. https://doi.org/10.3390/biomedicines11030876
Chicago/Turabian StyleNakagaito, Masaki, Teruhiko Imamura, Ryuichi Ushijima, Makiko Nakamura, and Koichiro Kinugawa. 2023. "Predictors and Outcomes of SGLT2 Inhibitor Discontinuation in a Real-World Population after Hospitalization for Heart Failure" Biomedicines 11, no. 3: 876. https://doi.org/10.3390/biomedicines11030876
APA StyleNakagaito, M., Imamura, T., Ushijima, R., Nakamura, M., & Kinugawa, K. (2023). Predictors and Outcomes of SGLT2 Inhibitor Discontinuation in a Real-World Population after Hospitalization for Heart Failure. Biomedicines, 11(3), 876. https://doi.org/10.3390/biomedicines11030876