Aims Prior studies suggest that sodium–glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF. Methods and results We conducted a population-based cohort study of adults with DM and AF between 2014 and 2019. Using a prevalent new-user design, individuals prescribed SGLT2i were matched 1:1 to those prescribed dipeptidyl peptidase-4 inhibitors (DPP4is) based on time-conditional propensity scores. The primary endpoint was a composite of AF-related healthcare utilization (i.e. hospitalization, emergency department visits, electrical cardioversion, or catheter ablation). Secondary outcome measures included all-cause mortality, heart failure (HF) hospitalization, and ischaemic stroke or transient ischaemic attack (TIA). Cox proportional hazard models were used to examine the association of SGLT2i with the study endpoint. Among 2242 patients with DM and AF followed for an average of 3.0 years, the primary endpoint occurred in 8.7% (n = 97) of patients in the SGLT2i group vs. 10.0% (n = 112) of patients in the DPP4i group [adjusted hazard ratio 0.73 (95% confidence interval 0.55–0.96; P = 0.03)]. Sodium–glucose cotransporter-2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalization, but there was no difference in the risk of ischaemic stroke/TIA. Conclusion Among patients with DM and pre-existing AF, SGLT2is are associated with decreased AF-related health resource utilization and improved arrhythmic outcomes compared with DPP4is.

中文翻译：

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钠-葡萄糖协同转运蛋白 2 抑制剂与糖尿病和既往心房颤动患者的心律失常结果之间的关联

目的 先前的研究表明钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2is) 可能会降低心房颤动 (AF) 的发生率。然而，尚不清楚 SGLT2i 是否可以减轻既往 AF 和 II 型糖尿病 (DM) 患者的 AF 病程。在这项研究中，我们的目的是检查 SGLT2i 处方与 DM 和既往 AF 患者心律失常结果之间的关联。方法和结果 我们在 2014 年至 2019 年间对患有 DM 和 AF 的成人进行了一项基于人群的队列研究。使用流行的新用户设计，将处方 SGLT2i 的个体与处方基于二肽基肽酶 4 抑制剂 (DPP4is) 的个体进行 1:1 匹配时间条件倾向得分。主要终点是与 AF 相关的医疗保健利用（即住院、急诊室就诊、电复律或导管消融）的综合。次要结局指标包括全因死亡率、心力衰竭（HF）住院治疗以及缺血性中风或短暂性脑缺血发作（TIA）。Cox 比例风险模型用于检查 SGLT2i 与研究终点的关联。在平均随访 3.0 年的 2242 名 DM 和 AF 患者中，SGLT2i 组 8.7% (n = 97) 的患者发生主要终点，而 DPP4i 组 10.0% (n = 112) 的患者发生主要终点[调整后风险比 0.73（95% 置信区间 0.55–0.96；P = 0.03）]。钠-葡萄糖协同转运蛋白 2 抑制剂与全因死亡率和心力衰竭住院率的显着降低相关，但缺血性中风/TIA 的风险没有差异。结论 在 DM 和既往存在 AF 的患者中，与 DPP4is 相比，SGLT2is 与 AF 相关的卫生资源利用率降低和心律失常结果改善相关。