The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials ; Rizik iznenadne srčane smrti i korištenje SGLT2 inhibitora u bolesnika sa zatajivanjem srca te utjecaj istih na velike ishode s obzirom na etiologiju kardiomiopatije : meta-analiza pivotalnih randomiziranih kontroliranih studija

Objectives: The present study aimed to examine the impact of SGLT2 inhibitor added to optimal medical therapy on the rates of sudden cardiac death (SCD) events among outpatients with heart failure, compared to placebo. Furthermore, we sought to investigate the potential differential impact of SGLT2 inhibitor with respect to etiology of heart failure (ischemic vs. non-ischemic cardiomyopathy) in HF patients treated with SGLT2 inhibitor. Patients and methods: Meta-analysis examined data from seven pivotal, large-scale, doubleblinded, placebo-controlled, randomized controlled trials conducted among HF outpatients. The primary outcome of interest was the impact of SGLT2i administration in patients with HF on the occurrence of SCD events, compared to placebo. Secondary goal was to assess the impact of SGLT2 inhibitor on the composite outcome of cardiovascular death or hospitalization for HF with respect to etiology of HF. Principal outcome measures were reported as a risk ratio (RR) with 95% confidence intervals (95% CI). Due to low heterogeneity across included studies, a fixed effects method with Mantel-Haenszel algorithm was used. Results: A total of 7 randomized clinical trials were included in the final analysis enrolling 21,637 outpatients with heart failure. The results of the present meta-analysis demonstrate that the addition of SGLT2 inhibitor to optimal medical therapy was associated with a relative risk reduction of SCD occurence by 20% (RR 0,80, 95% CI 0,65-0,98; P=0,030) when compared to placebo. Furthermore, the meta-analysis encompassing 7,232 patients from 3 studies revealed that among HF outpatients using SGLT2 inhibitor, on top of optimal medical therapy, occurence of the composite outcome including cardiovascular death and heart failure hospitalizations was reduced by 12% among patients with HF and non-ischemic cardiomyopathy compared to those with ischemic cardiomyopathy (RR 1,12, 95% CI 1,01-1,25; P=0,030). Both main results were derived from clinical trials that exhibited a low degree of ...