Use of SGLT-2 inhibitors in pediatric heart failure: a multi-center study

Introduction: There has been a rapid adoption of SGLT2i in pediatric heart failure despite a lack of evidence. To better understand the utilization and safety profile of SGLT2i, we collected data from patients treated at pediatric heart centers with SGLT2i. Methods: A multicenter retrospective study was performed utilizing ACTION’s pediatric heart failure registry. Patient demographics, heart failure medical regimen, echocardiographic data, laboratory data, adverse events and relevant heart failure outcomes were collected at SGLT2i initiation and last follow-up. Results: A total of 278 patients on SGLT2i from 19 institutions were enrolled. Median age at initiation was 15.1 years (IQR 10.7–18.2), 106 had DCM, 54 had Fontan physiology, 244 were prescribed dapagliflozin and 33 empagliflozin, and 67% of patients were initiated in the outpatient setting. 180/278 (65%) of patients had follow-up reported with median follow-up of 195 days (IQR 90–450). In the follow-up cohort, 32 patients discontinued SGLT2i, 15 due to drug intolerance, 8 due to VAD or transplant surgery, and 5 due to clinical improvement. 28 patients had a total of 34 adverse events reported (10 AKI, 11 UTI, 0 Ketosis). 13% patients had their loop diuretic reduced or discontinued at time of follow-up. After SGLT2i initiation, 13% of patients had a subsequent HF admission, 5% had a VAD, and 9% underwent heart transplantation. Conclusion: SGLT2i are being utilized in pediatric patients with HF from multiple etiologies and phenotypes. AKI and UTI were the most common reported adverse events while on SGLT2i. Prospective studies are needed to help determine efficacy.