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Association between sodium-glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation.
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- Author(s): Fichadiya A;Fichadiya A; Quinn A; Quinn A; Quinn A; Au F; Au F; Campbell D; Campbell D; Lau D; Lau D; Ronksley P; Ronksley P; Ronksley P; Beall R; Beall R; Beall R; Campbell DJT; Campbell DJT; Campbell DJT; Campbell DJT; Campbell DJT; Wilton SB; Wilton SB; Wilton SB; Wilton SB; Chew DS; Chew DS; Chew DS; Chew DS; Chew DS
- Source:
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2024 Mar 01; Vol. 26 (3).- Publication Type:
Journal Article- Language:
English - Source:
- Additional Information
- Source: Publisher: Oxford University Press Country of Publication: England NLM ID: 100883649 Publication Model: Print Cited Medium: Internet ISSN: 1532-2092 (Electronic) Linking ISSN: 10995129 NLM ISO Abbreviation: Europace Subsets: MEDLINE
- Publication Information: Publication: 2006- : Oxford : Oxford University Press
Original Publication: London ; Philadelphia : Saunders, c1999- - Subject Terms: Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/drug therapy ; Atrial Fibrillation*/diagnosis ; Atrial Fibrillation*/drug therapy ; Atrial Fibrillation*/epidemiology ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Ischemic Attack, Transient* ; Brain Ischemia* ; Stroke*/epidemiology ; Stroke*/prevention & control ; Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use ; Dipeptidyl-Peptidase IV Inhibitors*/pharmacology ; Heart Failure*/epidemiology ; Ischemic Stroke*; Adult ; Humans ; Cohort Studies ; Glucose ; Sodium ; Hypoglycemic Agents ; Retrospective Studies
- Abstract: Aims: Prior studies suggest that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF.
Methods and Results: We conducted a population-based cohort study of adults with DM and AF between 2014 and 2019. Using a prevalent new-user design, individuals prescribed SGLT2i were matched 1:1 to those prescribed dipeptidyl peptidase-4 inhibitors (DPP4is) based on time-conditional propensity scores. The primary endpoint was a composite of AF-related healthcare utilization (i.e. hospitalization, emergency department visits, electrical cardioversion, or catheter ablation). Secondary outcome measures included all-cause mortality, heart failure (HF) hospitalization, and ischaemic stroke or transient ischaemic attack (TIA). Cox proportional hazard models were used to examine the association of SGLT2i with the study endpoint. Among 2242 patients with DM and AF followed for an average of 3.0 years, the primary endpoint occurred in 8.7% (n = 97) of patients in the SGLT2i group vs. 10.0% (n = 112) of patients in the DPP4i group [adjusted hazard ratio 0.73 (95% confidence interval 0.55-0.96; P = 0.03)]. Sodium-glucose cotransporter-2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalization, but there was no difference in the risk of ischaemic stroke/TIA.
Conclusion: Among patients with DM and pre-existing AF, SGLT2is are associated with decreased AF-related health resource utilization and improved arrhythmic outcomes compared with DPP4is.
Competing Interests: Conflict of interest: D.L. has received in-kind support from Abbott Laboratories for a trial of continuous glucose monitors. S.B.W. has received grant funding from Servier Inc., unrelated to this work. D.S.C. reports grant funding from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. The remaining authors report no relevant disclosures.
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- Contributed Indexing: Keywords: Atrial fibrillation; DPP4 inhibitor; Heart failure; Hospitalization; SGLT2 inhibitor; Type II diabetes
- Accession Number: 0 (Sodium-Glucose Transporter 2 Inhibitors)
0 (Dipeptidyl-Peptidase IV Inhibitors)
IY9XDZ35W2 (Glucose)
9NEZ333N27 (Sodium)
0 (Hypoglycemic Agents) - Publication Date: Date Created: 20240314 Date Completed: 20240318 Latest Revision: 20240328
- Publication Date: 20240329
- Accession Number: PMC10939462
- Accession Number: 10.1093/europace/euae054
- Accession Number: 38484180
- Source:
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