USE OF SGLT2 INHIBITORS IN PATIENTS WITH HEART FAILURE TREATED AT A SPECIALIZED SUS CLINIC: A RETROSPECTIVE OBSERVATIONAL ANALYSIS AT QUALICIS IN GUARAPUAVA, PARANÁ

• DOI: https://doi.org/10.22533/at.ed.51572726240314

• Palavras-chave: heart failure; SGLT2 inhibitors; dapagliflozin; empagliflozin; ejection fraction; observational study.

• Keywords: heart failure; SGLT2 inhibitors; dapagliflozin; empagliflozin; ejection fraction; observational study.

• Abstract:

  Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have come to occupy a central role in the treatment of heart failure (HF), with demonstrated benefits across different ejection fraction ranges, regardless of the presence of diabetes mellitus. Objective: To evaluate, in a retrospective cohort of patients with heart failure followed in a specialized SUS service, echocardiographic, clinical, and renal outcomes observed after the use of SGLT2Is, with an emphasis on changes in left ventricular ejection fraction (LVEF), the occurrence of cardiovascular events, and serum creatinine trends. Methods: An observational, analytical, and retrospective study based on electronic medical records of 200 patients with HF followed at QUALICIS in Guarapuava, Paraná. Sociodemographic, clinical, echocardiographic, and laboratory variables were analyzed according to their availability in the records. Subanalyses of LVEF and creatinine were restricted to patients with documented paired measurements. For clinical outcomes, a descriptive analysis of events after initiation of therapy and an estimate of event-free survival using the Kaplan-Meier method were performed. Results: Among the 59 patients with paired LVEF, the mean change was +2.54 percentage points (SD ± 8.37), with a median of +5.0. Super-response, defined as an increase in LVEF of ≥ 10 percentage points, was observed in 27.1% (n = 16). Among the 22 patients with a baseline LVEF < 40%, 54.5% (n = 12) met the criteria for heart failure with a recovered ejection fraction. In the exploratory analysis of predictors, obesity showed a tendency toward a ssociation with super-response (41.7% versus 17.1%; OR 3.45; p = 0.07). Among 198 patients evaluated for events, 22 (11.1%) experienced a cardiovascular or hospitalization outcome after initiating iSGLT2. In the creatinine-matched subsample (n = 69), the mean change was +0.16 mg/dL (SD ± 0.55). Conclusion: In this real-world retrospective cohort, the use of iSGLT2 was associated with an overall favorable profile of clinical stability, a low frequency of recorded events, and echocardiographic and renal behavior consistent with the applicability of this class in a specialized outpatient setting within the Brazilian Unified Health System (SUS). The findings should be interpreted with caution due to the observational design, the absence of a control group, and the significant incompleteness of data.