1113 EFFICACY OF SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS IN HEART FAILURE WITH PRESERVED EJECTION FRACTION ACROSS DIFFERENT DEFINITIONS: A META-ANALYSIS OF PHASE 3 RANDOMIZED CONTROLLED TRIALS

Abstract Background Sodium glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve the prognosis of heart failure with preserved ejection fraction (HFpEF) in phase 3 randomized controlled trials (RCTs). However, a granular definition HF was adopted only most recent RCTs (hereafter, RCTs). In earlier studies, which assessed cardiovascular (CV) outcomes patients type diabetes (CV trials, CVOTs), status assigned based on medical history. Methods We searched for evaluating SGLT2i vs placebo HFpEF and published from inception Aug. 31st 2022, irrespective whether additional criteria were used define besides left ventricular ≥50%. Heterogeneity between studies examined by Cochran's Q test Higgins Thompsons’ I2 statistics. Risk ratios (RRs) 95% confidence intervals (95%CI) number needed treat (NNT) calculated random-effects model (moderate-to-high heterogeneity) or Mantel-Haenszel fixed-effect (low using R 4.2.1. Results Seven included meta-analysis: (EMPEROR-Preserved, DELIVER, SOLOIST-WHF) 4 CVOTs (EMPA-REG OUTCOME, DECLARE-TIMI58, VERTIS-CV, SCORED). The overall population 14,644 patients, mean follow-up 29.8±14.5 months (range: 9.0-50.4 months). risk composite outcome CV death hospitalization (HFH) significantly reduced SLGT2i as compared (RR 0.75, 95%CI 0.63-0.89, I2=59.7%, NNT 19). benefit confirmed displayed Figure; I2=75.7%, 13) (Figure; I2=56.9%, 26). Based available data (i.e., some selected studies), also had positive effect HFH 0.81, 0.73-0.90, I2=18.1%, 45), maintained both 37) I2=0.0% 46, respectively). all-cause neutral all 0.94, 0.85-1.04, I2=36.0%; RR 1.00, 0.92-1.08, I2=0.0%, respectively), considered separately (Figure). Conclusions efficacy consistent across stricter simpler HFpEF, supporting an extensive clinical use.