Prescribing trends of sodium-glucose cotransporter 2 Inhibitors in patients with heart failure with preserved, mildly reduced and reduced ejection fraction

Abstract Background Numerous randomized controlled trials have evaluated the efficacy of SGLT2i and demonstrated decreased hospitalization rates for HF and a better cardiorenal outcome in diverse heart failure (HF) populations comprising HF patients with reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF) ejection fraction. Since the beneficial effects of SGLT2i in HF patients are well known, real-world data on the clinical implementation of these agents following availability of CV outcome trial data seems of utmost importance. Methods We identified patients presenting with HF who were hospitalized at a university affiliated tertiary care center, between 01/2017 and 10/2022. All prescriptions of SGLT2i (dapagliflozin and empagliflozin) – including marketed fixed-dose combinations with other glucose-lowering drugs – were identified. Results In total, 2,673 patients with HF (median age 75, 39.9% female, 23.1% with diabetes) were included in the present analyses. Among the 2,637 patients with signs and symptoms suggestive of HF, 1086 (40.6%) had a documented left ventricular ejection fraction (LVEF) ≤ 40% (HFrEF), 445 (16.6%) a LVEF between 40-50% (HFmrEF) and 1142 (42.7%) a LVEF > 50% (HFpEF). In the overall cohort, 382 (14.3%) patients received an SGLT2i. As shown in Figure 1, the prescription of SGLT2i significantly increased from the beginning to the end of the inclusion period. In detail, it climbed from 6.8% in 2017 to 56.6% in 2022 in the HFrEF group (p-trend <0.001), from 3.3% to 49.2% in the HFmrEF group (p-trend <0.001) and from 1.9% to a still very low 26.4% in the HFpEF group (p-trend <0.001). While prescription of SGLT2i in HFrEF patients started to increase after the presentation of the DAPA-HF trial, the SGLT2i prescription in HFmrEF and HFpEF patients showed a marked rise after the presentation of the new HF ESC guidelines (2021) and the EMPEROR-Preserved trial. Conclusion The prescription of SGLT2i is constantly rising due to greater awareness among cardiologists and other specialists in internal medicine. Nevertheless, despite a growing evidence on the reduction of CV events by SGLT2i, our data show that there is still room for improvement in prescribing of these cardioprotective agents, especially in patients with HFpEF.Prescription trend of SGLT2i.