Heart failure & cardiomyopathies

Sodium-Glucose Cotransporter 2 Inhibitor Use for Heart Failure in US Ambulatory Cardiovascular Care

JAMA CardiolPublished Retrospective cohort study

Authors' conclusion

Although this study found that SGLT2i use had increased among ambulatory patients with HF during the study period, the majority of eligible patients did not receive this therapy. Older age, female sex, and higher blood pressures were associated with lower SGLT2i use with significant unexplained variation in use across practices.

Study context

Population
Patients with heart failure (HF) in US ambulatory CV care (National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry), July 2019–June 2023
Participants
759,915 patients191 US sites
Exposure
HF with Reduced EF (HFrEF) vs HF with Mildly Reduced EF (HFmrEF) or HF with Preserved EF (HFpEF)
Outcome
Patient-level and practice-level prescription of SGLT2i therapy
Methodological detailsregistry-based, national
  • Registry-based
  • National

Main finding

As reported in the abstract

SGLT2i prescription

Observational data: associations, not effects.

Further findings

Trend in SGLT2i use, Q3 2019 to Q2 2023

All HF: 4.6% to 16.2%
P for trend < 0.001
HFrEF: 5.1% to 28.5%
P for trend < 0.001
HFmrEF or HFpEF: 4.5% to 12.8%
P for trend < 0.001

Factors associated with SGLT2i use

Older age (IQR age, 80 vs 63 years): OR
0.76 (95% CI 0.75-0.77)
Female sex: OR
0.79 (95% CI 0.77-0.81)
Higher SBP: OR
0.78 (95% CI 0.77-0.79)
History of T2DM: OR
3.21 (95% CI 3.15-3.28)

Site-level variation in SGLT2i use (adjusted)

90th vs 10th percentile risk practice: adjusted OR
4.40 (95% CI 3.76-5.52)
  • Adjusted for patient- and practice-level characteristics

Original publication

Sodium-Glucose Cotransporter 2 Inhibitor Use for Heart Failure in US Ambulatory Cardiovascular Care. JAMA Cardiol. Published 1 September 2025. doi:10.1001/jamacardio.2025.2145

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