Meta-analyzing the factors affecting the efficacy of gliflozins in patients with heart failure based on heart failure trials

BACKGROUND: The factors affecting the efficacy of gliflozins in patients with heart failure (HF) are not clear. We aimed to evaluate the effects of 11 important factors on the efficacy of gliflozins in HF patients. METHODS: Randomized trials assessing gliflozins in HF patients were included. The outcome of interest was composite HF outcome, a composite of cardiovascular death, or hospitalization for HF. Meta-analysis was done according to 11 factors: status of type 2 diabetes, sex, use of angiotensin receptor-neprilysin inhibitor, age, history of hospitalization for HF, estimated glomerular filtration rate, body mass index, New York Heart Association (NYHA) class, race, region, and left ventricular ejection fraction. RESULTS: Compared with placebo, gliflozins reduced the risk of composite HF outcome by 14% in the subgroup of patients with NYHA class III or IV (hazard ratios [HR] 0.86, 95% confidence intervals [CI] 0.75–0.99), by 34% in the subgroup of patients with NYHA class II (HR 0.66, 95% CI 0.59–0.74), and by 85% in the subgroup of patients with NYHA class I (HR 0.15, 95% CI 0.03–0.73). This between-group difference was approximate to statistical significance (P(subgroup) = .06). The benefit of gliflozins in HF patients was not affected by the other 10 factors (P(subgroup) ≥ .123). CONCLUSIONS: Gliflozins are applicable for a broad population of HF patients as for preventing HF events, while gliflozins may lead to greater benefits in patients with mild HF than in those with moderate to severe HF.