SGLT2i Use for HF Rises in the US, But Not in All Hospitals

TOPLINE:

The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in US patients hospitalized with heart failure (HF) and a left ventricular ejection fraction > 40% increased substantially within 2 years after evidence from a clinical trial demonstrated benefits of the treatment, according to a new study, but researchers found significant variation found among hospitals.

METHODOLOGY:

• Researchers used data from the Get With The Guidelines-HF (GWTG-HF) registry to evaluate trends in the use of SGLT2 inhibitors by patients hospitalized for HF with a left ventricular ejection fraction > 40%, including subgroups with HF with mildly reduced ejection fraction (HFmrEF) or HF with preserved ejection fraction (HFpEF).
• They included 158,849 patients (median age, 76 years; 56.5% women) from 557 hospitals in the United States between July 2021 and September 2023; among them, 17.4% and 82.6% had HFmrEF and HFpEF, respectively.
• Among the 557 hospitals, 518 had 10 or more eligible discharges and were classified by prescription rates for SGLT2 inhibitors: 0%, > 0% to
• Analysis excluded patients receiving dialysis, those with an estimated glomerular filtration rate 2, and individuals discharged to hospice or leaving against medical advice.

TAKEAWAY:

• Roughly 1 in 7 patients were prescribed an SGLT2 inhibitor at discharge, with the quarterly prescription rates increasing from 4.2% in July-September 2021 to 23.5% in July-September 2023 (P for trend
• Higher prescription rates were observed among patients younger than 75 years, those with mildly reduced ejection fraction, Medicaid recipients, and Black, Hispanic, or other non-White individuals.
• Among the 518 hospitals, 2.1% achieved rates of SGLT2 inhibitor prescription of at least 50%, and 44.8% prescribed the medication to fewer than 10% eligible patients.
• Hospital-level variations remained substantial even after accounting for patient characteristics (adjusted median odds ratio, 2.12; P

IN PRACTICE:

“We found substantial variation across hospitals, highlighting the need to better understand the strategies used by higher prescribing centers to more rapidly increase SGLT2i adoption,” the study authors wrote.

“National initiatives, such as GWTG-HF registry quality measures, may be a strategy to increase adoption across US hospitals,” they added.

SOURCE:

This study was led by Mohammad Abdel Jawad, MD, of Saint Luke’s Mid America Heart Institute in Kansas City, Missouri. It was published online on November 18, 2024, in JAMA Cardiology.

LIMITATIONS:

This study was limited by the lack of data on SGLT2 inhibitor medication fills and adherence rates. The voluntary nature of the GWTG-HF registry may not have represented all US hospitals. This study examined only treatment at discharge, without capturing initiation of SGLT2 inhibitor therapy after patients left the hospital.

DISCLOSURES:

This study was supported by a grant from the American Heart Association. Some authors reported receiving grants, personal fees, and institutional support; serving on the board of directors; and having other ties with many institutions and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.