Adult Congenital Heart Disease International EValuation of the Effectiveness of SGLT2i Registry

In the adult congenital heart disease (ACHD) population, heart failure currently represents the main cause of morbidity and mortality. The etiology of ACHD-related heart failure is heterogenous, and there is limited evidence for pharmacological treatment options for this population.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a novel pillar in the treatment of conventional LV heart failure. SGLT2i have been shown to reduce the risk of worsening heart failure and cardiovascular-related death in patients with LV heart failure.

While the exact mechanisms of action are still to be elucidated, SGLT2i seem to address heart failure by targeting several pathways. These include but are not limited to; a decrease in renin-angiotensin and sympathetic nervous system activation, a decrease in pressure overload-induced myocardial fibrosis, reverse cardiac remodeling, and improvement in myocardial energetics.

Given the compelling evidence on the effectiveness of SGLT2i over a broad range of cardiac dysfunction and initial promising reports of its utilization in the field of ACHD, SGLT2i deserve further exploration in the group of ACHD patients.

This real-world, international registry aims to evaluate the current experience with SGLT2i in ACHD patients by investigating the prescription patterns, safety, tolerability, and potential beneficial effects on heart failure-related outcomes.

Project design:

Data of all ACHD patients who were started on an SGLT2i will be collected in a real-world, international registry. Only data resulting from routine clinical care will be collected from the electronic health records at the participating centers, and participants will not undergo any interventions for this project. Data will be collected from 1 year before starting with the SGLT2i to most recent follow-up after starting with the SGLT2i, to evaluate if SGLT2i therapy halts the progression of clinical deterioration in ACHD patients with heart failure and can improve heart failure-related outcomes.

• Side effects [Safety and Tolerability] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• SGLT2i-related complications [Safety and Tolerability] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• SGLT2i discontinuation [Safety and Tolerability] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Mortality [Safety and Tolerability] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Admissions [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Clinical parameters - weight [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Clinical parameters - systolic blood pressure [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Clinical parameters - diastolic blood pressure [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Clinical parameters - heart rate [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Clinical parameters - saturation [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Laboratory parameters - sodium [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]
• Laboratory parameters - potassium [Heart Failure-related Efficacy] [Time frame: From enrollment through study completion, with an average follow-up duration of 1 year.]