Objective:

To determine if SGLT-2 inhibitors decrease stroke recurrence and all-cause mortality at 90-days in patients with ischemic stroke and heart failure with low ejection fraction (HFrEF) of < 40%.

Background:

Multiple studies have shown that SGLT-2 inhibitors significantly reduce all-cause and cardiovascular mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, several of these trials have focused on primary prevention of cardiovascular and cerebrovascular outcomes. Direct evidence regarding mortality and secondary stroke prevention in ischemic stroke patients with low EF treated with SGLT-2 inhibitors remains an emerging area of research

Design/Methods:

Retrospective chart review study of consecutive adults over 18 with HFrEF of <40% presenting with ischemic stroke at a comprehensive stroke center and treated with or without SGLT-2 inhibitors.

Results:

Of a total of 163 patients, the mean age at stroke presentation was 68 years (SD ±13 years). Forty three (27%) were women and median NIHSS was 7 (IQR 3-18). Intravenous thrombolysis was administered in 20%. A total of 36 patients received SGLT-2 inhibitors following stroke onset of which 1 patient died at 90 days (3%) as compared to 27 deaths (21%) in the control group. This result was statistically significant (p=0.0095). We did not find a significant difference in the rate of recurrent strokes at 90 days (2 in the treatment group vs 3 in the controls).

Conclusions:

SGLT-2 inhibitors reduce all-cause mortality at 90 days in patients with ischemic stroke and HFrEF of <40%. Larger prospective studies are warranted to confirm these findings as well as assess the impact of secondary stroke prevention in this population.