Heart failure & cardiomyopathiesCohort study
Contemporary Use of Sodium-Glucose Cotransporter-2 Inhibitor Therapy Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction in the US
- Retrospective cohort study
- registry-based
- 489 sites
Authors' conclusion
In this study, prescription of SGLT2i at hospital discharge among eligible patients with HFrEF was low, including among patients with comorbid CKD and T2D who have multiple indications for therapy, with substantial variation among US hospitals.
Study context
- Population
- Patients hospitalized for heart failure with reduced ejection fraction (HFrEF) in the Get With The Guidelines-Heart Failure (GWTG-HF) registry, US, July 2021–June 2022, eligible for SGLT2i (eGFR <20, type 1 diabetes and prior SGLT2i intolerance excluded)
- Participants
- 49,399 patients · 489 sites
- Outcome
- Patient-level and hospital-level SGLT2i prescription at hospital discharge
- Follow-up
- Hospital discharge
Main finding
As reported in the abstract
SGLT2i prescription at discharge
Overall
20.2%
9988 events
- Hospitals (≥10 eligible discharges, n = 461) discharging ≥50% with SGLT2i
- 19 (4.1%)
- Hospitals discharging <25% with SGLT2i
- 344 (74.6%)
- Hospitals discharging zero with SGLT2i
- 29 (6.3%)
- Between-hospital variance, unadjusted: median OR
- 2.53 (95% CI 2.36-2.74)
- Between-hospital variance, adjusted for patient and hospital characteristics: median OR
- 2.51 (95% CI 2.34-2.71)
Observational data: associations, not effects.
Further findings
Between-hospital variance in SGLT2i prescription
| Comparison | median OR (95% CI) | P value | |
|---|---|---|---|
| Between hospitals · unadjusted | 2.53 (2.36–2.74) | ||
| Between hospitals · adjusted for patient and hospital characteristics | 2.51 (2.34–2.71) | ||
| 0.20.5125Median odds ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| SGLT2i prescription at discharge, by CKD (subgroup) · less likely with CKD | CKD 18.6% · 4550 of 24 437 · No CKD 21.8% · 5438 of 24 962 | P < 0.001 | |
| SGLT2i prescription at discharge, by T2D (subgroup) · more likely with T2D | T2D 26.2% · 5721 of 21 830 · No T2D 15.5% · 4262 of 27 545 | P < 0.001 | |
| SGLT2i prescription at discharge, by T2D and CKD (subgroup) | T2D and CKD 23.7% · 2905 of 12 236 · Others 19.1% · 7078 of 37 139 | P < 0.001 | |
| Background triple therapy (ACEi/ARB/ARNI, β-blocker, MRA), by SGLT2i prescription | SGLT2i 46.3% · 4624 of 9988 · No SGLT2i 27.6% · 10 880 of 39 411 | P < 0.001 |
Discharged with quadruple medical therapy including SGLT2i
- Quadruple therapy at discharge, of 49 399 total study patients
- 4624 (9.4%)
Hospital-level SGLT2i prescription (461 hospitals with ≥10 eligible discharges)
- Hospitals discharging ≥50% of patients with SGLT2i
- 19 (4.1%)
- Hospitals discharging <25% of patients with SGLT2i
- 344 (74.6%)
- Hospitals discharging zero patients with SGLT2i
- 29 (6.3%)
Original publication
Contemporary Use of Sodium-Glucose Cotransporter-2 Inhibitor Therapy Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction in the US. JAMA Cardiol. Published 1 July 2023. doi:10.1001/jamacardio.2023.1266
Summarised from the published abstract; every number is checked against it