Clinical Scorecard: Impact of Sodium–Glucose Cotransporter-2 Inhibitors on Clinical Outcomes in Diabetic Patients with Hypertrophic Cardiomyopathy: A Cohort Study Based on Population Data

At a Glance

Key Highlights

• SGLT2i use in HCM patients with diabetes was associated with a 24% reduction in composite risk of all-cause death and heart failure hospitalization.
• Significant reductions observed in all-cause mortality (44% lower), heart failure hospitalization (18% lower), sudden cardiac death (50% lower), and ischemic stroke (26% lower).
• Benefits of SGLT2i were consistent across subgroups including age, sex, atrial fibrillation status, and income levels.

Guideline-Based Recommendations

Diagnosis

• Confirm HCM diagnosis using ICD-10 codes I42.1 or I42.2 and registration under rare intractable diseases (RID) program code V127.
• Use imaging and expert review for accurate HCM diagnosis.

Management

• Consider SGLT2 inhibitors as part of antidiabetic therapy in patients with HCM and diabetes to reduce mortality and heart failure hospitalization.
• Recognize limited data on other heart failure medications specifically tested in HCM; SGLT2i shows promise based on cohort data.

Monitoring & Follow-up

• Monitor for clinical outcomes including all-cause death, heart failure hospitalization, sudden cardiac death, and ischemic stroke during SGLT2i therapy.
• Evaluate patient subgroups for consistent benefit regardless of age, sex, atrial fibrillation, or socioeconomic status.

Risks

• No specific risks of SGLT2i in HCM patients reported in this study; however, standard monitoring for SGLT2i adverse effects is advised.

Patient & Prescribing Data

Patients with confirmed HCM and diabetes initiating antidiabetic medications including SGLT2 inhibitors

SGLT2i use was associated with significantly improved clinical outcomes over a median follow-up of 3.1 years compared to non-use, supporting their benefit in this population.

Clinical Best Practices

• Use validated diagnostic criteria and registry codes to accurately identify HCM patients.
• Incorporate SGLT2 inhibitors in diabetic patients with HCM to reduce mortality and heart failure events.
• Apply propensity matching or similar methods in observational data to adjust for confounding when evaluating treatment effects.
• Consider comprehensive outcome assessment including mortality, heart failure hospitalization, sudden cardiac death, and ischemic stroke.
• Ensure consistent evaluation across demographic and clinical subgroups to confirm treatment benefit.

References

• Korean National Health Insurance Service Database
• Hypertrophic Cardiomyopathy Diagnosis and Management Guidelines
• SGLT2 Inhibitors in Heart Failure: Clinical Trials Overview