Lu Zhen Qi, McCourt Elizabeth, Goodhew Karen, Gupta Deepali, Chuan Francine, Mok Leonie, Peters Robyn, Ha Tina, Fowler Daniel, Dobbyn Daniel Michael, Hetherington Justine, Challa Prasad, Kannan Shanthi, Korczyk Dariusz, Russell Anthony, Mugwagwa Augustine Nyasha
Department of Cardiology, Redland Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2023 Nov;53(11):2085-2092. doi: 10.1111/imj.15993. Epub 2022 Dec 30.
The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown.
To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland.
Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021.
A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01).
During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.
2018年澳大利亚心力衰竭（HF）指南强烈建议，对于患有2型糖尿病（T2DM）的HF患者，开始使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2is）。在我们的医疗服务体系中，T2DM合并HF患者对SGLT-2is的使用情况尚不清楚。
通过评估昆士兰州东南部城市南部健康（MSH）医院T2DM合并HF患者使用SGLT-2is的时间趋势，来确定2018年HF指南的采用情况。
对2018年6月至2021年6月期间在MSH医院接受治疗的所有T2DM合并HF患者（射血分数（EF）<50%）进行回顾性分析。
共有666例患者符合纳入标准，共发生918次HF就诊。平均年龄为72岁，71%为男性（473/666）。平均EF为30%（标准差±11%），平均估计肾小球滤过率为48 mL/min/1.73 m²（标准差±25）。54%（362/666）的患者存在使用SGLT-2is的禁忌证。在无禁忌证的患者中，SGLT-2is的使用率增长了5倍，HF指南实施前为7%（2/29），实施后为38%（103/275）（P<0.001）。使用SGLT-2is的患者更年轻（64岁对69岁，P=0.002），HF住院次数更少（1.1次对2.1次，P=0.01）。
在研究期间，由于澳大利亚的处方指南/限制因素，我们54%的T2DM合并HF患者未使用SGLT-2is。我们观察到，在无SGLT-2is禁忌证的患者中，HF指南实施前后SGLT-2is的使用率显著增长了5倍。与未使用SGLT-2is的患者相比，使用SGLT-2is的患者HF住院次数明显更少。
