P47: SGLT2 Inhibitor Use in LVAD Patients is Associated with Reduced Diuretic Dose

Study: SGLT2 inhibitors (SGLT2-I) decrease morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF) and may reduce the dose requirement for diuretic therapy. This retrospective cohort study of patients with both HFrEF and Left Ventricular Assist Device (LVAD) support examined whether the addition of a SGLT2-I was associated with a reduced loop diuretic dose requirement. Methods: In this retrospective study, we reviewed HFrEF patients with LVAD support who were taking a diuretic and who were started on a SGLT2-I. Primary endpoint was diuretic dose 3 months before and after SGLT2-I. Statistical analysis was performed using paired student’s t-tests; p<0.05 was considered statistically significant. Results: From February 2021 to February 2022, 21 LVAD patients were identified who were taking a diuretic and were started on a SGLT2-I. Preliminary data revealed that 15 patients (71.4%) who were started on a SGLT2-I had a reduction in their diuretic dose within 3 months of drug initiation; 6 patients (28.5%) had their diuretics stopped within 3 months. There was a statistically significant difference in diuretic dose pre-SGLT2-I compared to 3 months after SGLT2-I initiation (3.26+/-1.91mg Bumetanide vs. 1.71+/-1.46mg Bumetanide, P=0.001), Figure 1. Additional findings included a 90 day readmission rate upon starting SGLT2-I to be 23.8% (5/21) compared to the 33.0% (14/42) 90-day readmission rate for new LVAD implanted patients at our facility in 2021. There were no documented urinary tract infections in patients started on a SGLT2-I in this study. Conclusions: Patients with HFrEF and LVAD support that are started on an SGLT2-I demonstrate a statistically significant reduction in diuretic use within 3 months of initiation of the drug.