Early Adoption of Sodium-Glucose Cotransporter-2 Inhibitor in Patients Hospitalized With Heart Failure With Mildly Reduced or Preserved Ejection Fraction.

IF 14.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Mohammad Abdel Jawad, John A Spertus, Uchechukwu Ikeaba, Stephen J Greene, Gregg C Fonarow, Karen Chiswell, Paul S Chan
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引用次数: 0

Abstract

Importance: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are the first therapy shown to improve clinical outcomes for patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) greater than 40%. Nationwide adoption of SGLT2is in the US since publication of the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction (EMPEROR-Preserved) in August 2021 is unknown.

Objective: To examine trends and hospital-level variation in SGLT2i adoption.

Design, setting, and participants: This cohort study included patients with LVEF greater than 40% who were hospitalized for decompensated HF at 1 of 557 sites in the US between July 1, 2021, and September 30, 2023, from the Get With The Guidelines-Heart Failure registry.

Main outcomes and measures: Patient-level trends and site-level variation in prescription rates of SGLT2i at hospital discharge. Site-level variation was quantified using the median odds ratio, which describes the average odds that a patient being treated at one vs another randomly selected hospital would receive SGLT2i therapy at discharge.

Results: Of 158 849 patients (median [IQR] age, 76 [66-85] years; 89 816 females [56.5%]), 22 126 eligible patients (13.9%) with HF and an LVEF greater than 40% were prescribed an SGLT2i at hospital discharge. Quarterly prescription rates increased from 4.2% in July to September 2021 to 23.5% in July to September 2023 (P for trend < .001). SGLT2i prescription was more likely among patients with HF with mildly reduced LVEF (41%-49%) than in those with preserved LVEF (≥50%; 5127 of 27 712 patients [18.5%] vs 16 999 of 131 137 patients [13.0%]; absolute standardized difference, 16.7%). After adjustment for patient characteristics, there was a high variance between hospitals in the rate of SGLT2i prescription (median odds ratio, 2.12; 95% CI, 2.02-2.25). Among 518 hospitals with 10 or more eligible discharges, 11 hospitals (2.1%) discharged 50% or more of their patients with an SGLT2i prescription, while 232 (44.8%) discharged fewer than 10% of eligible patients with an SGLT2i prescription.

Conclusion and relevance: For patients with HF and an LVEF greater than 40%, discharge prescription of SGLT2is increased from 4.2% to 23.5% during the first 2 years after the EMPEROR-Preserved trial demonstrating treatment benefits; however, these rates varied across US hospitals.

在射血分数轻度降低或保留的心力衰竭住院患者中尽早使用钠-葡萄糖共转运体-2 抑制剂。
重要性:钠-葡萄糖共转运体-2抑制剂(SGLT2is)是第一种被证明可改善左心室射血分数(LVEF)大于40%的心力衰竭(HF)患者临床疗效的疗法。自 2021 年 8 月发表 Empagliflozin Outcome Trial in Patients With Preserved Ejection Fraction(EMPEROR-Preserved)慢性心衰患者射血分数保留率试验以来,SGLT2is 在美国全国范围内的应用情况尚不清楚:研究采用 SGLT2i 的趋势和医院层面的差异:这项队列研究纳入了 2021 年 7 月 1 日至 2023 年 9 月 30 日期间在美国 557 个地点中的一个地点因失代偿性心力衰竭住院的 LVEF 大于 40% 的患者,这些患者来自 "Get With The Guidelines-Heart Failure "登记处:出院时 SGLT2i 处方率在患者层面的趋势和地点层面的变化。使用中位数几率比来量化医院层面的差异,中位数几率比描述了在一家医院接受治疗的患者与在另一家随机选择的医院接受治疗的患者在出院时接受 SGLT2i 治疗的平均几率:在 158 849 名患者(中位数[IQR]年龄为 76 [66-85] 岁;89 816 名女性[56.5%])中,22 126 名符合条件的 HF 患者(13.9%)在出院时接受了 SGLT2i 治疗。季度处方率从 2021 年 7 月至 9 月的 4.2% 增加到 2023 年 7 月至 9 月的 23.5%(P 为趋势结论和相关性):对于 LVEF 超过 40% 的心房颤动患者,在 EMPEROR-Preserved 试验证明治疗效果后的头两年,出院时 SGLT2i 的处方率从 4.2% 增加到 23.5%;然而,美国各家医院的处方率各不相同。
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来源期刊
JAMA cardiology
JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
45.80
自引率
1.70%
发文量
264
期刊介绍: JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.
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