The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials

Berntsen, Julia Kitty

prikaz prve stranice dokumenta The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials

diplomski rad

The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials

2023. urn:nbn:hr:171:421147

Berntsen, Julia Kitty

Sveučilište u Splitu
Medicinski fakultet

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APA 6th Edition

Berntsen, J. K. (2023). The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials (Diplomski rad). Split: Sveučilište u Splitu, Medicinski fakultet. Preuzeto s https://urn.nsk.hr/urn:nbn:hr:171:421147

MLA 8th Edition

Berntsen, Julia Kitty. "The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials." Diplomski rad, Sveučilište u Splitu, Medicinski fakultet, 2023. https://urn.nsk.hr/urn:nbn:hr:171:421147

Chicago 17th Edition

Harvard

Berntsen, J. K. (2023). 'The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials', Diplomski rad, Sveučilište u Splitu, Medicinski fakultet, citirano: 13.11.2024., https://urn.nsk.hr/urn:nbn:hr:171:421147

Vancouver

Berntsen JK. The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials [Diplomski rad]. Split: Sveučilište u Splitu, Medicinski fakultet; 2023 [pristupljeno 13.11.2024.] Dostupno na: https://urn.nsk.hr/urn:nbn:hr:171:421147

IEEE

J. K. Berntsen, "The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials", Diplomski rad, Sveučilište u Splitu, Medicinski fakultet, Split, 2023. Dostupno na: https://urn.nsk.hr/urn:nbn:hr:171:421147

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Podaci o radu

Naslov	The risk of sudden cardiac death and use of SGLT2 inhibitors in patients with heart failure and effect on major outcomes with respect to etiology of cardiomyopathy : a meta analysis of pivotal randomized controlled trials
Naslov (hrvatski)	Rizik iznenadne srčane smrti i korištenje SGLT2 inhibitora u bolesnika sa zatajivanjem srca te utjecaj istih na velike ishode s obzirom na etiologiju kardiomiopatije : meta-analiza pivotalnih randomiziranih kontroliranih studija
Autor	Julia Kitty Berntsen
Mentor	Josip Anđelo Borovac (mentor)
Član povjerenstva	Duška Glavaš (predsjednik povjerenstva)
Član povjerenstva	Joško Božić (član povjerenstva)
Član povjerenstva	Marino Vilović (član povjerenstva)
Ustanova koja je dodijelila akademski / stručni stupanj	Sveučilište u Splitu Medicinski fakultet Split
Datum i država obrane	2023-07-11, Hrvatska
Znanstveno / umjetničko područje, polje i grana	BIOMEDICINA I ZDRAVSTVO Kliničke medicinske znanosti Interna medicina
Sažetak	Objectives: The present study aimed to examine the impact of SGLT2 inhibitor added to optimal medical therapy on the rates of sudden cardiac death (SCD) events among outpatients with heart failure, compared to placebo. Furthermore, we sought to investigate the potential differential impact of SGLT2 inhibitor with respect to etiology of heart failure (ischemic vs. non-ischemic cardiomyopathy) in HF patients treated with SGLT2 inhibitor. Patients and methods: Meta-analysis examined data from seven pivotal, large-scale, doubleblinded, placebo-controlled, randomized controlled trials conducted among HF outpatients. The primary outcome of interest was the impact of SGLT2i administration in patients with HF on the occurrence of SCD events, compared to placebo. Secondary goal was to assess the impact of SGLT2 inhibitor on the composite outcome of cardiovascular death or hospitalization for HF with respect to etiology of HF. Principal outcome measures were reported as a risk ratio (RR) with 95% confidence intervals (95% CI). Due to low heterogeneity across included studies, a fixed effects method with Mantel-Haenszel algorithm was used. Results: A total of 7 randomized clinical trials were included in the final analysis enrolling 21,637 outpatients with heart failure. The results of the present meta-analysis demonstrate that the addition of SGLT2 inhibitor to optimal medical therapy was associated with a relative risk reduction of SCD occurence by 20% (RR 0,80, 95% CI 0,65-0,98; P=0,030) when compared to placebo. Furthermore, the meta-analysis encompassing 7,232 patients from 3 studies revealed that among HF outpatients using SGLT2 inhibitor, on top of optimal medical therapy, occurence of the composite outcome including cardiovascular death and heart failure hospitalizations was reduced by 12% among patients with HF and non-ischemic cardiomyopathy compared to those with ischemic cardiomyopathy (RR 1,12, 95% CI 1,01-1,25; P=0,030). Both main results were derived from clinical trials that exhibited a low degree of heterogeneity (I2=0%). All included studies showed low risk of bias, as adjudicated independently by two investigators. Conclusion: The use of SGLT2 inhibitor, on top of optimized background therapy for heart failure, among heart failure outpatients, was associated with a 20% relative risk reduction in the occurrence of sudden cardiac death, compared to placebo. Similarly, SGLT2 inhibition appears to be more effective in heart failure patients with non-ischemic etiology of cardiomyopathy vs. those with ischemic etiology, although this effect should be cautiously interpreted due to the small effect size and wide confidence intervals.
Sažetak (hrvatski)	Ciljevi: Ciljevi ovog rada su istražiti utjecaj dodatka SGLT2 inhibitora optimalnoj medicinskoj terapiji na pojavnost događaja iznenadne srčane smrti među vanbolničkim bolesnicima sa zatajivanjem srca u usporedbi s placebom. Nadalje, istražili smo potencijalni diferencijalni efekt SGLT2 inhibitora s obzirom na etiologiju srčanog zatajivanja (ishemijska naspram neishemijskoj kardiomiopatiji) u bolesnika sa zatajivanjem srca koji su liječeni sa SGLT2 inhibitorima. Pacijenti i metode: Ova meta-analiza je obradila podatke iz sedam pivotalnih, velikih, dvostruko zaslijepljenih, placebom kontroliranih, randomiziranih kontroliranih studija koje su provedene u vanbolničkih bolesnika sa zatajivanjem srca. Primarni ishod od interesa je bio učinak korištenja SGLT2 inihbitora u odnosu na placebo, a s obzirom na pojavnost događaja iznenadne srčane smrti. Sekundarni cilj je bio istražiti utjecaj SGLT2 inhibitora na kompozitni ishod koji se sastojao od kardiovaskularne smrtnosti ili hospitalizacija zbog zatajivanja srca, a s obzirom na etiologiju zatajivanja srca. Glavne mjere ishoda koje su korištene je omjer rizika (RR) sa 95% intervalima pouzdanosti (95% CI). Zbog utvrđene niske heterogenosti uključenih studija, statistička metoda fiksnih učinaka sa Mantel-Haenszelovim algoritmom je korištena za generiranje rezultata meta-analize. Rezultati: Ukupno je u analizu uključeno 7 randomiziranih kliničkih studija koje su uključile ukupno 21,637 bolesnika sa zatajivanjem srca. Glavni rezultat ukazuje na to da je dodatak SGLT2 inhibitora optimalnoj medicinskoj terapiji povezan sa značajnim smanjenjem relativnog rizika za pojavnost iznenadne srčane smrti za 20%, u usporedbi sa placebom (RR 0,80, 95% CI 0,65-0,98; P=0,030). Nadalje, meta-analitičko združivanje rezultata 7,232 bolesnika iz 3 studije je pokazalo da je SGLT2 inhibitor, povrh optimalne medicinske terapije smanjio relativni rizik za pojavnost kompozitnog ishoda kardiovaskularne smrti ili hospitalizacije zbog zatajivanja srca za 12% kod bolesnika sa neishemijskom kardiomiopatijom u odnosu na bolesnike sa ishemijskom kardiomiopatijom (RR 1,12%, 95% CI 1,01-1,25; P=0,030). Oba glavna rezultata su postignuta analizom studija za koje se pokazalo da imaju nizak stupanj heterogeneosti (I2=0%). Sve navedene studije su imale nizak rizik od pristranosti prema neovisnoj procjeni dvoje istraživača. Zaključci: Uporaba SGLT2 inhibitora pored ostale optimizirane terapije za zatajivanje srca, među vanbolničkim bolesnicima, bila je povezana sa smanjenjem relativnog rizika iznenadne srčane smrti za 20% u odnosu na placebo. Slično tomu, naši rezultati sugeriraju da su SGLT2 inhibitori bili efikasniji u redukciji pojavnosti kompozitnog ishoda kardiovaskularne smrti ili hospitalizacija zbog zatajivanja srca u bolesnika sa neishemijskom naspram ishemijske etiologije zatajivanja srca. Međutim, opisani učinak je potrebno interpretirati sa posebnim oprezom s obzirom na relativno malu veličinu efekta i širok raspon intervala pouzdanosti.
Ključne riječi
Ključne riječi (hrvatski)
Jezik	engleski
URN:NBN	urn:nbn:hr:171:421147
Studijski program	Naziv: Medicina na engleskom jeziku Vrsta studija: sveučilišni Stupanj studija: integrirani preddiplomski i diplomski Akademski / stručni naziv: doktor/doktorica medicine (dr. med.)
Vrsta resursa	Tekst
Način izrade datoteke	Izvorno digitalna
Prava pristupa	Otvoreni pristup
Uvjeti korištenja
Datum i vrijeme pohrane	2023-07-07 08:54:32