AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
SGLT2 Inhibitors and Incident Atrial Fibrillation: A SMART-C Collaborative Meta-Analysis
By Patel S, Im K, Neuen B et al.
Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been definitively shown to improve heart failure (HF) and kidney outcomes. Individual trial analyses suggest that SGLT2i may also reduce the risk of atrial fibrillation or flutter (AF/AFL), though this remains incompletely characterized, particularly across different patient populations. Methods: The SGLT2i meta-analysis cardio-renal trialists consortium (SMART-C) facilitates access to aggregate data across large randomized placebo-controlled trials (RCTs) of SGLT2i that enrolled patients with either 1) type 2 diabetes (T2D) at high risk for atherosclerotic cardiovascular disease (ASCVD), 2) HF irrespective of T2D, or 3) chronic kidney disease (CKD) with or without T2D. The outcome of interest for this collaborative meta-analysis was incident AF/AFL in patients without baseline history of AF/AFL. Incident AF/AFL was prospectively captured as a pre-specified investigator-reported outcome across the HF trials and derived from adverse event reporting among the non-HF trials. Trial effect estimates were meta-analyzed and pooled using fixed effects, with further stratification by trial population. Results: In total, 56,876 patients without history of AF/AFL at baseline across 10 RCTs (57%, 19%, and 25% from T2D at high risk for ASCVD, HF and CKD RCTs respectively) were included. Of these patients, 1,580 (2.8%) experienced an AF/AFL event during follow-up. SGLT2i reduced the risk of incident AF/AFL overall (0.88 [95% CI 0.80-0.98]; p=0.017). The effect was directionally consistent across the different trial populations, though with moderate heterogeneity ( I ² = 60%) ( Figure ). Conclusion: Overall, SGLT2i appear to reduce the risk of incident AF/AFL in those without a history of AF/AFL at baseline.