The role of SGLT-2i in the primary prevention of atrial fibrillation (AF) remains unclear from clinical trials. We assessed the association of SGLT-2i use and incident AF in routine clinical practice. Using Medicare claims data 2013-2018, we identified patients with type 2 diabetes (T2D) and aged ≥66 years with no AF history (i.e., no diagnosis, procedure or medication codes suggestive of underlying AF at baseline) initiating an SGLT-2i or a comparator (a DPP-4i or a GLP-1RA) , in two pairwise comparisons (74,868 and 80,475 1:1 propensity score-matched pairs, respectively) . The primary outcome was AF hospitalization. Secondary outcomes were AF diagnosis in any care setting and AF treated with medications. We calculated hazard ratios (HRs) and rate differences (RDs, per 1000 patient-year) , in the matched groups, well-balanced across 138 baseline covariates. Over a median follow-up of approximately 6 months, the risk of AF hospitalization was lower in the SGLT-2i group than the DPP-4i group (HR, 0.82 [95%CI, 0.76-0.89]; RD, -3.7 [95%CI, -5.2, -2.2]) or the GLP-1RA group (HR, 0.90 [95%CI, 0.83-0.98]; RD, -1.8 [95%CI, -3.2, -0.3]) (Table) . Findings for secondary outcomes were consistent with the primary outcome. In routine care, SGLT-2i use was associated with a reduction in the risk of incident AF, compared to DPP-4i or GLP-1RA among older patients with T2D.


M.Zhuo: None. J.M.Paik: None. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate. B.M.Everett: Consultant; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Lilly, Provention Bio, Inc., UpToDate, Other Relationship; American Heart Association, Research Support; Novo Nordisk. E.D'andrea: None. R.Glynn: None. S.C.Kim: Research Support; AbbVie Inc., Bristol-Myers Squibb Company, Pfizer Inc., Roche Pharmaceuticals. E.Patorno: Research Support; Boehringer Ingelheim International GmbH, National Institutes of Health, Patient-Centered Outcomes Research Institute.

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