Impact of sodium-glucose cotransporter 2 inhibitors on bleeding, hospitalizations, and other adverse outcomes in atrial fibrillation patients with and without diabetes.

INTRODUCTION

Emerging evidence suggests that sodium‑glucose cotransporter 2 inhibitors (SGLT2is) may be associated with a reduced risk of arrhythmias and related complications.

OBJECTIVES

We aimed to evaluate the impact of SGLT2is on atrial fibrillation (AF)-associated adverse outcomes.

PATIENTS AND

METHODS

All anticoagulated patients with AF diagnosed between January 2014 and December 2020 were identified from a federated electronic medical record database (TriNetX), and followed‑up for 3 years. A 1:1 propensity score matching (PSM) analysis was performed to balance SGLT2i and non‑SGLT2i cohorts. Primary outcomes were bleeding, hospitalizations for AF/atrial flutter (AFl), composite of cardioversion and ablations, and ventricular arrhythmias (VAs) and cardiac arrests. Secondary outcomes included all‑cause mortality, ischemic stroke / transient ischemic attack (TIA), hemorrhagic stroke, incident heart failure (HF), myocardial infarction, and composite of arterial and venous thrombotic events (TEs). Subanalyses were performed on AF‑diabetes and AF‑HF cohorts.

RESULTS

As many as 789 758 and 86 249 patients were identified from the non‑SGLT2i and SGLT2i groups, respectively. After PSM, each group had 51 320 patients. The SGLT2i use was associated with a significantly lower risk of bleeding (hazard ratio [HR], 0.669; 95% CI, 0.642-0.697), hospitalization for AF/AFl (HR, 0.826; 95% CI, 0.815-0.837), composite of cardioversion / ablation (HR, 0.652; 95% CI, 0.628-0.678), and VAs and cardiac arrests (HR, 0.779; 95% CI, 0.754-0.805). A lower risk of all‑cause mortality (HR, 0.554; 95% CI, 0.537-0.571), ischemic stroke/TIA (HR, 0.795; 95% CI, 0.768-0.823), hemorrhagic stroke (HR, 0.691; 95% CI, 0.623-0.767), incident HF (HR, 0.856; 95% CI, 0.821-0.893), myocardial infarction (HR, 0.763; 95% CI, 0.736-0.792), and composite of arterial / venous TEs (HR, 0.719; 95% CI, 0.704-0.735) was also observed.

CONCLUSIONS

The SGLT2i use was associated with a lower risk of AF‑related complications.