EFFECT OF SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS IN ADULTS WITH CONGENITAL HEART DISEASE

Aim: Robust evidence-based treatment options are lacking for adult congenital heart disease (ACHD) patients with heart failure (HF). This study evaluated the safety, tolerability, and short-term HF-related effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a real-world ACHD population.
Sample and Methodology: All ACHD patients treated with SGLT2i in four European ACHD centers were included in this international, multicenter, retrospective cohort study. Data were collected from one year before starting SGLT2i to the most recent follow-up. Data on safety and tolerability (side effects and discontinuation), mortality, NT-proBNP, and hospitalizations were collected.
Results: In total, 174 ACHD patients were treated with SGLT2i from April 2016 to July 2023. The mean age was 48.7 (±15.3) years, 72 (41.4%) were female, and 29 (16.7%) had type 2 diabetes mellitus. Ten (5.7%) patients had mild, 75 (43.1%) moderate and 89 (51.1%) severe congenital heart disease. HF was the most frequent starting indication (n=162, 93.1%), followed by type 2 diabetes (n=11, 6.3%) and chronic kidney disease (n=1, 0.6%). After a median follow-up of 7.7 [3.9–13.2] months, 18 patients (10.3%) reported side effects, 12 (6.9%) permanently discontinued SGLT2i, and 4 (2.3%) died of SGLT2i unrelated causes. A significant reduction in HF-hospitalization rate was observed from the 6 months before to the 6 months after starting SGLT2i (relative hospitalization rate=0.30 [95% confidence interval 0.14–0.62], p=0.001).
Conclusion: SGLT2i were generally well-tolerated and safe in 174 ACHD patients. SGLT2i was associated with a 3-fold reduction in the 6-month HF hospitalization rate. The positive effects observed warrant further prospective randomized investigation of the potential benefits of SGLT2i for ACHD patients.