Heart failure & cardiomyopathiesCohort study
Early initiation of sodium–glucose co-transporter-2 inhibitors in heart failure patients: a nationwide study
- nationwide study
- French National Healthcare Database (SNDS)
- multilevel logistic regression
Authors' conclusion
In this nationwide study, SGLT-2i initiation increased over the years but remains suboptimal and highly variable across hospitals and patient phenotypes, highlighting opportunities to improve GDMT.
Study context
- Population
- Patients discharged from a first heart failure (HF) hospitalization, excluding patients with prior exposure to SGLT-2i, 2021–2023
- Participants
- 303,118 patients
Main finding
As reported in the abstract
SGLT-2i initiation
Initiated SGLT-2is
16.1%
Observational data: associations, not effects.
Further findings
| Outcome | Values |
|---|---|
| SGLT-2i initiation by patient characteristics | ≤75 years vs. older 24.3% vs. 12.4% · males vs. females 19.7% vs. 12.4% · diabetics vs. non-diabetics 18.9% vs. 14.8% · without CKD vs. with CKD 17.4% vs. 11.4% · LVEF <40% 36.1% · 40%-49% 19.7% · ≥50% 11.7% |
- SGLT-2i initiation by patient characteristics: Left ventricular ejection fraction (LVEF) P for trend <0.001
SGLT-2i initiation over time · 2021 to 2023
- 2021
- 4.8%
- 2023
- 28.5%
- P for trend <0.001
- similar trends across subgroups
Predictors of SGLT-2i initiation
- Positive predictors: male sex, critical care unit stay, diabetes, lower LVEF and background guideline-directed medical therapy (GDMT)
- Negative predictors: older age and chronic kidney disease (CKD)
Between-hospital variance in SGLT-2i initiation
- Median odds ratio (MOR)
- 1.55, 95% CI 1.50-1.60
- Hospitals sharing more than half of SGLT-2i initiators
- 25%
Original publication
Early initiation of sodium–glucose co-transporter-2 inhibitors in heart failure patients: a nationwide study. ESC Heart Fail. Published 8 January 2026. doi:10.1093/eschf/xvaf009
Summarised from the published abstract; every number is checked against it