Evidence map›Paper›PMID 40464647›Full record

SynthesisEuropean heart journal. Cardiovascular pharmacotherapy2025

Prevention of atrial fibrillation with SGLT2 inhibitors across the spectrum of cardiovascular disorders: a meta-analysis of randomized controlled trials.

Damiano Fedele, Marcello Casuso Alvarez, Angelo Maida, Nicolò Vasumini, Sara Amicone, Lisa Canton, Michele Di Leo, Marco Basile, Tommaso Manaresi, Francesco Angeli and 3 more

Abstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal. Cardiovascular pharmacotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  14. OCEAN trial: rethinking long-term anticoagulation after atrial fibrillation ablation.European heart journal. Cardiovascular pharmacotherapy · 2026
    Article
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  16. Observational
  17. Review
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  19. Preventing atrial fibrillation with SGLT2 inhibitors: time, sex, and substrate.European heart journal. Cardiovascular pharmacotherapy · 2025
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Damiano FedeleDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Marcello Casuso AlvarezDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Angelo MaidaDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Nicolò VasuminiDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Sara AmiconeDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Lisa CantonDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Michele Di LeoDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Marco BasileDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Tommaso ManaresiDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Francesco AngeliDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Matteo ArmillottaDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Luca BergamaschiDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.
Carmine PizziDepartment of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, Bologna 40126, Italy.ORCID 0000-0002-4048-675X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsThe ability of sodium-glucose co-transporter 2 (SGLT2) inhibitors to prevent atrial fibrillation (AF) has been evaluated in various studies with conflicting results. This study aimed to determine whether SGLT2 inhibitors have a protective effect against AF depending on the baseline clinical condition in which the randomized controlled trials (RCTs) were conducted. METHODS AND

resultsA trial-level meta-analysis was performed including 52 RCTs (112 031 patients) comparing SGLT2 inhibitors with placebo and reporting the number of patients who developed AF in each arm. Risk ratios (RRs) for AF development with 95% confidence intervals (95% CIs) were pooled using a random-effects model. Subgroup analyses were performed by classifying RCTs according to the inclusion criteria of each trial [diabetes, chronic kidney disease, heart failure with reduced ejection fraction (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF)]. Overall, SGLT2 inhibitors prevented AF (RR = 0.86, 95% CI 0.77-0.96). In the subgroup analysis, the AF-preventive ability of SGLT2 inhibitors was influenced by HF, being preserved in RCTs recruiting 9141 patients with HFrEF, but not in those recruiting 12 877 subjects with HFmrEF/HFpEF (P-value for group difference = 0.01). Meta-regression showed a reduced efficacy of SGLT2 inhibitors in preventing AF when more patients with hypertension or higher EF were enrolled (P < 0.01 for both).

conclusionSodium-glucose co-transporter 2 inhibitors prevent AF. Their protective effect was confirmed in the HFrEF subgroup, but not in RCTs recruiting patients with HFmrEF/HFpEF, possibly indicating a different pathophysiology leading to AF among these conditions. However, given the limitations of a trial-level analysis, these findings are exploratory, pending confirmation from patient-level data.

Indexed as

Atrial FibrillationSodium-Glucose Transporter 2 InhibitorsHumansMaleRandomized Controlled Trials as TopicRisk FactorsTreatment OutcomeSodium-Glucose Transporter 2 InhibitorsAtrial fibrillationDiastolic dysfunctionHeart failureHeart failure with preserved ejection fractionHeart failure with reduced ejection fractionSGLT2 inhibitors

Identifiers

PMID40464647
PMCPMC12342982

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.