Effect of Sodium-Glucose Cotransporter 2 Inhibitors in Adults With Congenital Heart Disease.

Background: Heart failure (HF) is the principal cause of morbidity and mortality in adults with congenital heart disease (ACHD). Robust evidence-based treatment options are lacking.
Objectives: This study aims to evaluate the safety, tolerability, and short-term HF-related effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a real-world ACHD population.
Methods: All patients with ACHD treated with SGLT2i in 4 European ACHD centers were included in this retrospective study. Data were collected from 1 year before starting SGLT2i to the most recent follow-up. Data on side effects, discontinuation, mortality, and hospitalizations were collected.
Results: In total, 174 patients with ACHD were treated with SGLT2i from April 2016 to July 2023. The mean age was 48.7 ± 15.3 years, 72 (41.4%) were female, and 29 (16.7%) had type 2 diabetes mellitus. Ten (5.7%) patients had mild, 75 (43.1%) moderate, and 89 (51.1%) severe congenital heart disease. HF was the most frequent starting indication (n = 162, 93.1%), followed by type 2 diabetes (n = 11, 6.3%) and chronic kidney disease (n = 1, 0.6%). At median follow-up of 7.7 months (Q1-Q3: 3.9-13.2 months), 18 patients (10.3%) reported side effects, 12 (6.9%) permanently discontinued SGLT2i, and 4 (2.3%) died of SGLT2i-unrelated causes. A significant reduction in the HF hospitalization rate was observed from 6 months before to 6 months after starting SGLT2i (relative rate = 0.30; 95% CI: 0.14-0.62; P = 0.001).
Conclusions: SGLT2i generally seem safe, well-tolerated, and potentially beneficial in patients with ACHD. SGLT2i was associated with a 3-fold reduction in the 6-month HF hospitalization rate. These results warrant prospective randomized investigation of the potential benefits of SGLT2i for patients with ACHD.
Competing Interests: Funding Support and Author Disclosures Dr Neijenhuis has received support from the Foundation “De Drie Lichten” (Hilversum, the Netherlands), AstraZeneca, and the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding. Dr Zemrak has received speaker fees from Abbott Laboratories. Dr Rotmans has received an unrestricted research grant from AstraZeneca. Dr Jongbloed has received support from the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding; and has received a personal grant from the NWO/ZonMw (The Hague, the Netherlands), the Bontius Foundation (Leiden, the Netherlands), and the Rembrandt Institute (Leiden, the Netherlands). Dr Egorova has received support from the Leiden University Medical Center research council Cardio-Vascular cluster Themes for Innovation funding; and has received consultancy and speaker fees from Boston Scientific Corporation and Medtronic Inc. The Department of Cardiology of the Leiden University Medical Center has received unrestricted research and educational grants from Boston Scientific Corporation, Medtronic, and Biotronik. The funders were not involved in study design, collection, analysis, interpretation of data, the writing of this paper, or the decision to submit it for publication. No artificial intelligence programs contributed to the compilation of the submitted manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)