Safety of Initiating Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Heart Failure or Type 2 Diabetes and a History of Urinary Tract Infections

Background: Despite being a pillar of heart failure (HF) management, the guideline-directed initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2is) may be challenging due to the barrier of associated urinary tract infections (UTIs). Although there is a known risk, it remains unclear whether UTI incidence differs between patients with and without a prior history of UTIs. Methods: This study aimed to evaluate the risk–benefit profile of initiating an SGLT2i in patients with a history of UTIs. This retrospective, single-center healthcare system cohort analysis included adult patients hospitalized and taking an SGLT2i between 1 January 2020, and 31 August 2024. The included patients were divided into two cohorts: patients with and without a history of UTI pre-SGLT2i (described in this study as UTI-naive). Patients with urogenital structural abnormalities, indwelling catheters, or high-risk profiles were excluded. The primary outcome was the incidence of UTIs post-SGLT2i initiation. Secondary outcomes included the number of UTIs within 30, 60, and 90 days after starting an SGLT2i. Results: A total of 280 patients were evaluated for this study, of which 250 were included for analysis. Of those, 197 were UTI-naive, and 53 had a history of UTI pre-SGLT2i use. The most utilized SGLT2i was empagliflozin (75.6%). Amongst the cohorts, 20.4% of the UTI-naive patients developed a UTI post-SGLT2i versus 30.2% in patients with a historical UTI (p = 0.13). Conclusions: There was no significant difference in UTIs developed up to 90 days post-SGLT2i initiation, regardless of previous infections, suggesting that a history of UTI should not be a barrier to differing first-line therapy.