The impact of SGLT-2 Inhibitors on the Risk of Atrial Fibrillation in Heart Failure

BackgroundHeart failure (HF) and atrial fibrillation (AF) are closely linked, each exacerbating the other. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) are known to provide substantial benefits in HF management, their effect on AF incidence in this population is not well-defined. ObjectiveThis study aims to assess the effect of SGLT2i therapy on the development of new-onset AF in patients with HF. MethodsThis retrospective analysis included all patients hospitalized with a primary diagnosis of HF and no prior diagnosis of AF over a 3-year period. The primary outcome was the occurrence of new-onset AF within 12 months following HF hospitalization. ResultsOf 3,953 patients 720 (18.2%) developed AF within one year. SGLT2i use was associated with significantly lower risk of AF (HR 0.69, 95% CI:0.55-0.87; p=0.002) across all HF types-reduced, mid-range, and preserved ejection fraction. Kaplan-Meier survival analysis revealed significantly reduced AF-free survival in patients not on SGLT2i therapy, compared to patients on SGLT2i therapy, across subgroups categorized by diabetes, hypertension, coronary artery disease, age [&ge;]65 years, and BMI [&ge;]30Kg/m2 (p <0.05 for all). Among those who developed AF, SGLT2i use had significantly lower incidence of AF during follow-up as compared to when not used (12.1% vs. 19.5%, p<0.001). SGLT2 use also delayed onset of AF compared to those not treated with an SGLT2i (339 {+/-} 80 days vs. 317 {+/-} 106 days; p<0.001). ConclusionsThe use of SGLT2i therapy is associated with a significantly lower risk of the developing AF following hospitalization for HF.