I Putu Agus Arsana, - (2022) Cardiovascular And Renal Outcome Of Sodium Glucose Cotransporter-2 Inhibitor (Sglt2i) Versus Mineralocorticoid Receptor Antagonist (Mra) In Heart Failure With Reduced Ejection Fraction (Hfref) Patients: Systematic Review And Meta Analysis. Skripsi thesis, UNIVERSITAS AIRLANGGA.

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Abstract

"Background: Overall number of people with heart failure is increasing because of a substantial increase in predisposing or comorbid diseases. It is now known that sodium glucose cotransporter 2 inhibitor (SGLT2i) has a favorable effect on the prognosis of heart failure reduced ejection fraction (HfrEF) patients. However, there are still no studies or trials that directly compare SGLT2i with other first-line HFrEF pharmacotherapy drugs. Aims: This study is aimed to determine the effect of SGLT2i on cardiovascular and renal outcome in HFrEF, determine the effect of MRA on cardiovascular and renal outcome in HFrEF, compare the effect of SGLT2i with MRA, and find whether combination of SGLT2i and MRA is better than monotherapy. Methods: This research is systematic review and meta-analysis with literature research using e-database such as Scopus, Pubmed, Science direct, and ClinicalTrial.gov. The primary efficacy outcome was the composite of cardiovascular death or hospitalization for heart failure. Study Quality Assessment was done by version 2 of the Cochrane risk of bias tool for randomized trial (RoB 2). Fixed or random effect Mantel-Haenszel model was used for dichotomous data to calculate the pooled risk ratio (RR) and 95% confidence interval (CI). Indirect treatment comparison (ITC) analysis and assessing confidence was performed on Confidence in Network Meta-Analysis (CINeMA) with a fixed model. The use of P < 0.05 was considered to indicate statistical significance. Result: Total of seven trials were included. SGLT2i was found to significantly in reduce the risk of cardiovascular death or hospitalization for heart failure by 24% (RR 0.76, 95% CI 0.70-0.81), cardiovascular death by 15% (RR 0.85, 95% CI 0.75-0.96), hospitalization for heart failure by 28% (RR 0.72, 95% CI 0.65-0.80), and worsening renal function by 39% (RR0.61, 95% CI 0.47-0.80). The reduction in cardiovascular death or hospitalization for heart failure was of similar magnitude in patients with or without diabetes mellitus (RR 0.74, 95% CI 0.69-0.81 vs RR 0.78, 95% CI 0.68-0.89). MRA also was found to significantly in reduce the risk of cardiovascular death or hospitalization for heart failure by 22% (RR 0.78, 95% CI 0.68-0.90), cardiovascular death by 20% (RR 0.80, 95% CI 0.74-0.87), hospitalization for heart failure by 20% (RR 0.80, 95% CI 0.69-0.93), but non-significant on worsening renal function (RR 1.13, 95% CI 0.44-2.93). Indirect IR-PERPUSTAKAAN UNIVERSITAS AIRLANGGA x SKRIPSI CARDIOVASCULAR AND RENAL… I PUTU AGUS treatment comparison showed that MRA and SGLT2i had similar effects on primary outcome (RR 1.083, 95% CI 0.991-1.183). And combination of SGLT2i and MRA better than MRA monotherapy (RR 0.77, 95% CI 0.69-0.85). Conclusion: SGLT2i and MRA could safely and give excellent prognosis on cardiovascular outcome in HFrEF patients. SGLT2i safely reduces worsening renal function, but not in MRA. SGLT2i and MRA demonstrate similar effects, while combination of SGLT2i and MRA results in a better cardiovascular protective effect. "

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