Abstract 4358777: Adverse Events Associated with Early vs. Late SGLT2i Initiation After Heart Failure Hospitalization: A Target Trial Emulation Study
Bibliographic record
Abstract
Introduction: Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) are guideline-directed medical therapy for heart failure, their safety in patients with acute decompensated heart failure (ADHF) remains uncertain. This study compared the risk of adverse events between early versus late initiation of SGLT2is following ADHF hospitalization. Methods: We conducted a retrospective cohort study emulating a target trial using linked administrative data from Ontario, Canada. Adults aged ≥66 years discharged after hospitalization for ADHF between April 1, 2016, and March 31, 2021 were included. Patients with prior SGLT2i use or with prior heart failure hospitalizations were excluded. We compared two strategies for initiating SGLT2is: early initiation (within 30 days post-discharge), and late initiation (between days 31 and 365 after discharge). The primary outcome was a composite of eight prespecified adverse events requiring hospitalization or emergency department visit within one year of discharge (diabetic ketoacidosis, genitourinary infections, hypotension/syncope, dehydration, acute kidney injury, and falls/fractures). We applied a clone-censor-weight approach, using inverse probability weighted Cox regression models to estimate cause-specific hazard ratios (csHR) and cumulative incidence functions to account for the competing risk of death. Multiple imputation was used to deal with missing values of serum creatinine. Results: The mean number of included patients across 32 imputed datasets was 58,744 (median age, 83 years [IQR 77–89]; 53.4% women). In the overall cohort, during the 1-year follow-up, 18.2% experienced at least one adverse event, most commonly genitourinary infections (5.9%) and acute kidney injury (4.9%). At one year, no difference in the risk of adverse events was observed between the early and late initiation strategies (cumulative incidence at 1 year was 14.5% in the early and 18.7% in the late initiation strategies; absolute risk difference: 4.1%; csHR: 0.96; 95% CI 0.90 to 1.01; p=0.13). Sensitivity analyses using alternative definitions of early and late initiation yielded similar results. Conclusions: In this population-based target trial emulation study, there was no difference in the risk of one-year adverse events with early initiation of SGLT2i within 30 days post-discharge for ADHF compared with delayed initiation. These findings support the safety of early SGLT2i initiation in patients recently hospitalized for ADHF.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.019 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".