Sodium Glucose Co-transporter 2 Inhibitors In Left Ventricular Assist Device Patients: A Double-Edged Sword in Advanced Heart Failure; Insight from Propensity-Matched, Real-World Multicentric Analysis

Sodium glucose co-transporter 2 inhibitors (SGLT2i) have shown cardiovascular and renal benefits in heart failure, diabetics and chronic kidney disease patients, yet their effect in left ventricular assist device (LVAD) patients remains unclear. We conducted a retrospective study using TriNetX research network (2016-present) to study clinical outcomes in LVAD patients with and without SGLT2i therapy. Primary outcomes included all cause mortality, driveline infection, right heart failure, cardiorenal syndrome and atrial fibrillation. Propensity score matching was applied based on demographics and comorbidities to minimize confounding. A total of 6,532 LVAD patients were identified, with 2,224 receiving SGLT2i therapy. Following 1:1 propensity score matching; two balanced cohorts of 2,217 each were identified. SGLT2i use was associated with a 30.5% reduction in all-cause mortality (CI -33%, -28%, P < 0.0001, OR 0.228), however,SGLT2i users noted to have higher rates of drive-line infection (CI 1.39%, 5.55%, P <0.001, OR 1.32), right heart failure (CI 11.69%, 17.00%, P<0.0001, OR 2) and cardiorenal syndrome (7.13%,12.94%, P<0.0001, OR 1.49). No significant difference was observed in atrial fibrillation incidence between the two cohorts. In LVAD patients; SGLT2i use was associated with significant mortality benefits but increased risk of certain complications; including drive-line infection, right heart failure and cardiorenal syndrome. These observations highlight the need for further prospective studies of SGLT2i therapy in this complex population.