Bertram Pitt, MD, a professor of medicine emeritus at the University of Michigan School of Medicine, spoke with us about the role of sodium–glucose co-transporter-2 (SGLT2) inhibitors when treating heart failure (HF). Initially developed to treat diabetes, these drugs have been shown to improve HF outcomes in HF in several large, randomized trials over the past few years, including SOLOIST-WHF, DAPA-HF, EMPEROR-Preserved, and the DELIVER trials. The positive results earned their inclusion in the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.
"The SGLT-2 inhibitors have played a major role in HF. The results from the SGLT2 inhibitors, especially the selective ones with empagliflozin and dapagliflozin, are really pretty sensational," Pitt said.
Pitt focused on data from the SOLOIST-WHF trial he was involved in, including data from a recent sub-analysis delivered at the American Heart Association (AHA) 2022 meeting this past November. The study focused on the SGLT2 agent sotagliflozin.
"We had significant reductions in out primary endpoint, which was cardiovascular mortality and heart failure events," Pitt explained.
The new data is from a subset of just under 600 patients in the SOLOIST-WHF trial who were prescribed sotagliflozin prior to discharge and monitored at 30 and 60 days for rehospitalization rates compared to patients who were not on the drug. At 30 days, there was about a 50% reduction in the primary endpoint or reducing HF hospitalizations our cardiovascular deaths.
"By 90 days, we had a significant reduction in cardiovascular events, and the curves diverged pretty rapidly," he said. "That has some pretty important implications. We know in the United States there are many hospitals penalized if they have hospital readmissions from heart failure, so the fact that we can reduce it 40-50% is a big deal.
More importantly, Pitt explained, many patients will not get started on the drug at all or only much later after discharge, unless they are started on the drug prior to discharge and given a prescription to continue taking it. He said that is the biggest takeaway from the data presented at AHA.
"It has important implications for quality of life, because patients are not in the hospital, and there is a healthcare cost implication, because if you can prevent additional rehospitalizations, that is going to add up," Pitt said.
Additional analysis from the SOLOIST-WHF trial and the sotagliflozin SGLT2 agent will be presented at the 2023 American College of Cardiology (ACC) meeting March 4-6. Find information about these sessions.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com