Bassi Nikhil S, Ziaeian Boback, Yancy Clyde W, Fonarow Gregg C
Division of Cardiology, University of California, Los Angeles (UCLA).
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Cardiol. 2020 Aug 1;5(8):948-951. doi: 10.1001/jamacardio.2020.0898.
Sodium-glucose cotransporter 2 inhibitor (SGLT2-i) therapy provided incremental survival benefit to patients with heart failure and reduced ejection fraction (HFrEF) who received guideline-directed medical therapy regardless of type 2 diabetes status in a recent clinical trial. To date, estimation of the potential benefits that could be gained from optimal implementation of SGLT2-i therapy at the population level has not been quantified.
To quantify the projected gains for deaths prevented or postponed with comprehensive implementation of SGLT2-i therapy for patients with HFrEF in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model, performed from September 25 to October 20, 2019, used published sources to estimate the US population of patients with HFrEF eligible for SGLT2-i therapy and the numbers needed to treat to prevent or postpone overt death. Sensitivity analyses were performed to account for the range of potential benefits.
All-cause mortality.
Of the 3.1 million patients with HFrEF in the United States, 2 132 800 (69%) were projected to be candidates for SGLT2-i therapy. Optimal implementation of SGLT2-i therapy was empirically estimated to prevent up to 34 125 deaths per year (range 21 840-49 140 deaths per year). A secondary analysis excluding patients on the basis of N-terminal-pro brain natriuretic peptide levels and other trial entry criteria would yield a potential benefit of 25 594 deaths per year prevented (range, 16 380-36 855 deaths per year prevented).
This study suggests that a substantial number of deaths in the United States could be prevented by optimal implementation of SGLT2-i therapy. These data support implementation of the current evidence into practice in a timely manner to achieve important public health benefits and to reduce the mortality burden of HFrEF.
在最近一项临床试验中，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2-i）疗法为接受指南指导药物治疗的射血分数降低的心力衰竭（HFrEF）患者带来了额外的生存益处，且与2型糖尿病状态无关。迄今为止，尚未对在人群层面最佳实施SGLT2-i疗法可能获得的潜在益处进行量化估计。
量化在美国全面实施SGLT2-i疗法对HFrEF患者预防或推迟死亡的预期获益。
设计、背景和参与者：该决策分析模型于2019年9月25日至10月20日进行，利用已发表的资料估计美国符合SGLT2-i疗法的HFrEF患者人群以及预防或推迟显性死亡所需治疗的人数。进行敏感性分析以考虑潜在益处的范围。
全因死亡率。
在美国310万HFrEF患者中，预计2132800人（69%）适合SGLT2-i疗法。根据经验估计，最佳实施SGLT2-i疗法每年最多可预防34125例死亡（每年范围为21840 - 49140例死亡）。一项基于N末端脑钠肽前体水平和其他试验纳入标准排除患者的二次分析显示，每年可预防25594例死亡（每年范围为16380 - 36855例死亡）。
本研究表明，在美国通过最佳实施SGLT2-i疗法可预防大量死亡。这些数据支持及时将现有证据应用于实践，以实现重要的公共卫生效益并减轻HFrEF的死亡率负担。
