The effect of SGLT2 inhibitor on clinical outcomes in patients with type 2 diabetes and atrial fibrillation

BackgroundSodium glucose cotransporter 2 (SGLT2) inhibitors improve clinical outcomes in several populations including type 2 diabetes, chronic renal insufficiency, and heart failure (HF). However, limited data exist on their effects on atrial fibrillation (AF). MethodsWe conducted a retrospective cohort study using the National Health Insurance Service database. A total of 4,771 patients with type 2 diabetes and AF who were newly prescribed SGLT2 inhibitors or DPP4 inhibitors were selected and matched in a 1:2 ratio by propensity score with 37 confounding variables. We assessed the effect of SGLT2 inhibitors on the composite outcome of either HF hospitalization or death compared with DPP4 inhibitors. ResultsOver a median follow-up of 31 months, patients on SGLT2 inhibitors were associated with a lower risk of hospitalizations for HF or mortality compared to those on 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) and CV mortality (HR 0.43; 95% CI 0.21-0.86; P=0.018), but not of MI (HR 1.22 [95% CI 0.72-2.09]; P=0.461) or stroke (HR 1.00 [95% CI 0.75-1.33]; P=0.980). The incidence of hospitalizations for HF, although statistically insignificant, tended to be lower in the SGLT2 inhibitor group (HR 0.63 [95% CI 0.39-1.02]; P=0.062). ConclusionIn a nationwide cohort of patients with type 2 diabetes and AF, SGLT2 inhibitor was associated with a lower risk of mortality compared to DPP4 inhibitor, which may suggest that SGLT2 inhibitors may be considered as the first-line antidiabetic medication in patients with type 2 diabetes and AF.