Safety of SGLT-2 inhibitors in the management of heart failure in the adult congenital heart disease patient population

Background: Sodium glucose transporter 2 inhibitors (SGLT-2i) have shown safety and efficacy in patients with heart failure (HF). However, evidence for the use of SGLT-2i in adult congenital heart disease (ACHD) patients with HF is limited. Methods: We performed a retrospective, single center analysis of 18 patients (>18 years of age) with ACHD and a diagnosis of HF who were initiated on an SGLT-2i. Patient characteristics, including vital signs, laboratory values, concomitant medications, clinical outcomes, and echocardiograms, were obtained as part of standardized clinical care at our ACHD program before and 2-6 months after initiation of SGLT-2i. The primary outcome was to demonstrate safety of SGLT-2i initiation via potential changes in systolic blood pressure, serum sodium, and serum creatinine. Results: Of the 18 patients, 11 (61%) had moderate complexity congenital heart disease while 7 (39%) had great complexity congenital heart disease. Post initiation, there were no significant differences in systolic blood pressure (121.8 +/- 20.8 mmHg to 114.4 +/- 14.9 mmHg, p = 0.06), sodium level (138.7 +/- 2.9 mMol/L to 138.0 +/- 2.2 mMol/L, p = 0.75), and creatinine level (0.85 +/- 0.18 mg/dL to 0.89 +/- 0.18 mg/dL, p = 0.07). There was a statistically significant decline in weight (78.9 +/- 22.9 kg to 76.0 +/- 23.0 kg, p = 0.0039) but without a statistically significant change in NT -pro NBP (1358.2 +/- 2735.0 pg/mL to 601.6 +/- 786.1 pg/mL, p = 0.36). Conclusions: We demonstrated the use of SGLT-2i in a small cohort of ACHD population, including patients with complex congenital heart disease, appears safe and well tolerated. The safety and potential efficacy of SGLT-2i in patients with ACHD will require further evaluation in prospective multicenter studies.