The impact of SGLT-2 Inhibitors on the Risk of Atrial Fibrillation in Heart Failure.

Background: Heart failure (HF) and atrial fibrillation (AF) are closely linked, each exacerbating the other. While sodium-glucose cotransporter-2 inhibitors (SGLT2i) are known to provide substantial benefits in HF management, their effect on AF incidence in this population is not well-defined.

Objective: This study aims to assess the effect of SGLT2i therapy on the development of new-onset AF in patients with HF.

Methods: This retrospective analysis included all patients hospitalized with a primary diagnosis of HF and no prior diagnosis of AF over a 3-year period. The primary outcome was the occurrence of new-onset AF within 12 months following HF hospitalization.

Results: Of 3,953 patients 720 (18.2%) developed AF within one year. SGLT2i use was associated with significantly lower risk of AF ( ) across all HF types-reduced, mid-range, and preserved ejection fraction. Kaplan-Meier survival analysis revealed significantly reduced AF-free survival in patients not on SGLT2i therapy, compared to patients on SGLT2i therapy, across subgroups categorized by diabetes, hypertension, coronary artery disease, age ≥65 years, and BMI ≥30Kg/m (p <0.05 for all). Among those who developed AF, SGLT2i use had significantly lower incidence of AF during follow-up as compared to when not used (12.1% vs. 19.5%, p<0.001). SGLT2 use also delayed onset of AF compared to those not treated with an SGLT2i (339 ± 80 days vs. 317 ± 106 days; ).

Conclusions: The use of SGLT2i therapy is associated with a significantly lower risk of the developing AF following hospitalization for HF.