| Objective:In addition to standard treatments for heart failure,the effects of sodium-glucose cotransporter 2 inhibitors(SGLT2i)on cardiovascular outcomes in patients with chronic heart failure with mid-range ejection fraction(HFmr EF)is not fully understood.To observe the effects of SGLT2 i dagliazine on cardiovascular outcomes in chronic HFmr EF patients with or without type 2 diabetes mellitus(T2DM)in the real world.Methods:This was a single-center retrospective cohort study.A total of 728 patients with chronic HFmr EF with or without T2 DM from our hospital from January 2019 to December 2021 were selected as subjects and divided into exposure group and control group according to different treatment regimens.Control group was treated with guide-oriented conventional heart failure medications,including angiotensin converting enzyme inhibitor(ACEI)/angiotensin II receptor blocker(ARB)/angiotensin-receptor neprilysin inhibitor(ARNI),beta blocker,salocorticoid receptor antagonists,diuretics,cardiostimulants,and vasodilators.The exposure group was combined with SGLT2 i Dagliazine tablets 10 mg once a day on the basis of conventional drug therapy for heart failure,and the two groups were treated with maintenance regimen for at least 6 months.Demographic data,past history,present history,some laboratory test results,echocardiography and other data of patients were collected.Using SGLT2 i as the grouping variable,age,sex,history of smoking,history of drinking,history of hypertension,history of diabetes,history of hyperlipidemia,history of coronary heart disease,history of stroke,history of percutaneous coronary intervention(PCI),history of coronary artery bypass grafting(CABG),history of permanent pacemaker implantation,left ventricular ejection fraction(LVEF),estimated glomerular filtration rate(e GFR)and B-type natriuretic peptide(BNP)level were used as the matching factors of propensity score.The two groups were matched with propensity scores.The primary end point event was a composite end point of hospitalization for heart failure,emergency visits for heart failure,or death from cardiovascular causes,and the secondary end point event was all-cause death.SPSS 26.0(IBM SPSS Statistics 26.0)software was used for data statistical analysis,and The R Programming Language was used for data visualization.The Kaplan-Meier method was used to generate a survival curve,and multivariate Cox proportional hazard regression was used to analyze the endpoint events.The treatment effect was expressed in terms of risk ratio(HR)and 95%confidence interval(95%CI).All P-value tests were bilateral tests,and P<0.05 indicated statistically significant differences.Results:1 GroupingA total of 728 with chronic HFmr EF patients with or without T2 DM were included in this study,including 192 in the exposed group and 536 in the control group.Compared with the control group,patients in the exposure group were younger,had higher levels of e GFR,LVEF,and BNP,and had higher rates of smoking,alcohol consumption,hypertension,diabetes,hyperlipidemia,coronary heart disease,and PCI.SGLT2 i was used as grouping variable to perform 1:1 propensity score matching(caliper value0.15),and 108 matching pairs were generated after propensity score matching.In the exposed group,75 males(69.4%)and 33 females(30.6%),aged 40 to 80 years old,average(63.2±9.1)years old.In the control group,there were 66(61.1%)males and 42(38.9%)females,ranging in age from 30 to 89 years old,with an average age of(62.3±11.9)years old.Baseline characteristics of exposed group and control group were balanced,with no statistical difference(P>0.05).2 Comparison of risk of major composite end point events between the exposure group and the control groupThere were significant differences in the risk of major composite end point events between the two groups.The 3-year cumulative incidence of major composite end point events was 0.28 in the exposure group and 0.46 in the control group,respectively.The risk of major composite end point events in the exposure group was significantly lower than that in the control group(HR=0.51,95%CI: 0.30-0.86,P=0.010).2.1 Comparison of risk of hospitalization for heart failure between exposed and control groupsThe 3-year cumulative incidence of hospitalization for heart failure was0.25 in the exposure group and 0.40 in the control group,respectively.The risk of hospitalization for heart failure was significantly reduced in the exposure group compared with the control group(HR=0.53,95%CI:0.30-0.94,P=0.027).2.2 Comparison of risk of emergency visits for heart failure between exposed and control groupsThe 3-year cumulative incidence of emergency visits for heart failure was 0.14 in the exposure group and 0.26 in the control group,respectively.The risk of emergency visits for heart failure was significantly lower in the exposure group than in the control group(HR=0.43,95%CI: 0.20-0.97,P=0.035).2.3 Comparison of risk of death from cardiovascular causes between the exposure group and the control groupThe 3-year cumulative incidence of death from cardiovascular causes was 0.05 in the exposure group and 0.14 in the control group,respectively.The risk of death from cardiovascular causes was significantly lower in the exposure group than in the control group(HR=0.44,95%CI:0.15-1.28),but there was no statistical difference.3 Comparison of the risk of secondary endpoint events between the exposure group and the control groupThe 3-year cumulative incidence of all-cause death for secondary endpoints was 0.21 in the exposure group versus 0.36 in the control group.The risk of all-cause death was lower in the exposure group than in the control group(HR=0.54,95%CI:0.26-1.10),but there was no statistical difference.Conclusions:SGLT2i dagliazine significantly reduced the combined endpoint risk of hospitalization for heart failure,emergency visits for heart failure,and death from cardiovascular causes in chronic HFmr EF patients with or without T2 DM.This effect may stem primarily from the fact that SGLT2 i dagliazine significantly reduced the risk of hospitalization for heart failure and emergency visits for heart failure in chronic HFmr EF patients with or without T2 DM. |
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