935-P: Cardiovascular and Mortality Outcomes with SGLT2 Inhibitors in Patients with Atrial Fibrillation and Type 2 Diabetes

Introduction & Objective: Sodium glucose cotransporter 2 (SGLT2) inhibitors have shown clinical benefits in patients with heart failure (HF), chronic kindey disease and type 2 diabetes(T2DM). However, limited data exist on their effects on clinical outcomes in patients with AF and T2DM.

Methods: We conducted a retrospective cohort study using the National Health Insurance Service database of Korea. A total of 4,771 patients with T2DM and AF who were newly prescribed SGLT2 inhibitors or DPP4 inhibitors were selected and matched by propensity score in a 1:2 ratio. The effect of SGLT2 inhibitors on the composite outcome of either HF hospitalization or death compared with DPP4 inhibitors were examined. Consistency of the drug effect on the primary outcome in subgroups and the effect of SGLT2 inhibitor according to follow-up period after the time of initiation were analyzed.

Results: Over a median follow-up of 31 months, SGLT2 inhibitors showed a lower risk of hospitalizations for HF or death compared to use of DPP4 inhibitors (HR 0.61; 95% CI 0.44-0.85; P=0.004). SGLT2 inhibitor use was also associated with a lower risk of mortality (HR 0.61; 95% CI 0.39-0.94; P=0.025). SGLT2 inhibitors were associated with a lower risk of HF hospitalization or mortality regardless of prior ASCVD or HF history. Patients with SGLT2 inhibitors demonstrated a significantly lower risk of primary outcome from 90 days after initiating the drug to the third year, as compared with those with DPP4 inhibitors (P<0.05).

Conclusion: In a nationwide cohort of patients with T2DM and AF, SGLT2 inhibitors showed a lower risk of mortality compared to DPP4 inhibitors. This may support the use of SGLT2 inhibitors as the first-line antidiabetic medication in patients with T2DM and AF to prevent adverse outcomes.