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Effect of SGLT2 Inhibitors on Quality of Life by Race in HF Patients
Quick Takes
- There is a consistent and statistically significant health status benefit of SGLT2 inhibitors in both Black and White patients with HF.
- These data suggest that SGLT2 inhibitors should be used with confidence among Black patients with HF.
- Efforts to ensure equitable access to these treatments in all races have the potential to improve the health status of Black and White patients with HF.
Study Questions:
What is the treatment effect of sodium–glucose cotransporter 2 (SGLT2) inhibitors (vs. placebo) on health status for Black compared with White patients with heart failure (HF)?
Methods:
The investigators combined patient-level data from three randomized clinical trials of SGLT2 inhibitors: DEFINE-HF (Dapagliflozin Effect on Symptoms and Biomarkers in Patients With Heart Failure; n = 263), PRESERVED-HF (Dapagliflozin in Preserved Ejection Fraction Heart Failure; n = 324), and CHIEF-HF (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure; n = 448). These three United States-based trials enrolled a substantial proportion of Black patients, and each used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure health status at baseline and after 12 weeks of treatment. Among 1,035 total participants, selecting self-identified Black and White patients with complete information yielded a final analytic cohort of 935 patients. The primary endpoint was KCCQ Clinical Summary score. Twelve-week change in KCCQ with SGLT2 inhibitors versus placebo was compared between Black and White patients by testing the interaction between race and treatment using multivariable linear regression models adjusted for trial, baseline KCCQ (as a restricted cubic spline), race, and treatment.
Results:
Among 935 participants, 236 (25%) self-identified as Black, and 469 (50.2%) were treated with an SGLT2 inhibitor. Treatment with an SGLT2 inhibitor, compared with placebo, resulted in KCCQ Clinical Summary score improvements at 12 weeks of +4.0 points (95% confidence interval [CI], 1.7-6.3; p = 0.0007) in White patients and +4.7 points (95% CI, 0.7-8.7; p = 0.02) in Black patients, with no significant interaction by race and treatment (p = 0.76). Other KCCQ scales showed similar results.
Conclusions:
The authors report that treatment with an SGLT2 inhibitor resulted in consistent and significant improvements in health status for both Black and White patients with HF.
Perspective:
This study combined data from three randomized trials to create the largest reported cohort of Black patients, treated with an SGLT2 inhibitor versus placebo, and report a consistent and statistically significant health status benefit of SGLT2 inhibitors in both Black and White patients with HF. Moreover, this is the first analysis to demonstrate a significant improvement in short-term quality of life in Black patients with HF (across the entire spectrum of ejection fraction) treated with an SGLT2 inhibitor. These data suggest that SGLT2 inhibitors should be used with confidence among Black patients with HF. Such efforts to ensure equitable access to these treatments in all races have the potential to improve the health status of Black and White patients with HF.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Acute Heart Failure
Keywords: African Americans, Health Status, Health Status Disparities, Heart Failure, Metabolic Syndrome, Quality of Life, Race Factors, Secondary Prevention, Sodium-Glucose Transporter 2 Inhibitors, Sodium-Glucose Transporter 2, Stroke Volume
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