Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Baylor Scott and White Research Institute, Dallas, TX, USA.
Eur J Heart Fail. 2023 Jul;25(7):999-1009. doi: 10.1002/ejhf.2864. Epub 2023 Apr 24.
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are effective across the spectrum of left ventricular ejection fraction (LVEF) in heart failure (HF); however, population-wide medication use in eligible patients remains suboptimal. We evaluated the potential implications of optimal global implementation of SGLT-2 inhibitors in HF.
A decision analytical study was performed using the global prevalence of HF from the Global Burden of Disease 2017 report. Exclusion criteria were applied using the NHANES to ascertain an SGLT-2 inhibitor-eligible population, which was mapped onto global LVEF distributions from the REPORT-HF registry. The number needed to treat for 3 years for the composite of worsening HF events and cardiovascular deaths was calculated from estimated event rates in the DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, and DELIVER trials and projected onto the eligible population. An estimated 49 329 000 (95% confidence interval [CI] 43 882 000-54 929 000) HF patients would be eligible for SGLT-2 inhibitors across all LVEFs, including 25 651 000 (95% CI 22 818 000-28 563 000) with LVEF ≤40% and 23 678 000 (95% CI 21 063 000-26 366 000) with LVEF >40%. Optimal implementation of SGLT-2 inhibitors would be projected to prevent/postpone 4 512 011 (95% CI 4 013 686-5 024 232) to 5 986 943 (95% CI 5 325 721-6 666 604) total worsening HF events and cardiovascular deaths over 3 years in patients with LVEF <40%. An additional 2 102 606 (95% CI 1 870 394-2 341 301) to 2 557 224 (95% CI 2 274 804-2 847 528) total worsening HF events and cardiovascular deaths would be prevented/postponed in patients with LVEF >40%. Among all eligible HF patients, irrespective of LVEF, 7 069 235 (95% CI 6 288 490-7 871 760) to 8 089 549 (95% CI 7 196 115-9 007 905) total worsening HF events and cardiovascular deaths would be prevented/postponed over this period.
Optimal implementation of SGLT-2 inhibitors globally in HF is projected to prevent/postpone approximately 7-8 million worsening HF events and cardiovascular deaths over 3 years.
钠-葡萄糖共转运蛋白-2（SGLT-2）抑制剂在心力衰竭（HF）的整个左心室射血分数（LVEF）范围内均有效；然而，在符合条件的患者中，药物的广泛使用仍不理想。我们评估了在 HF 中全面实施 SGLT-2 抑制剂的潜在影响。
使用全球疾病负担 2017 年报告中的 HF 全球患病率进行决策分析研究。使用 NHANES 排除标准确定 SGLT-2 抑制剂适用人群，并将其映射到 REPORT-HF 登记处的全球 LVEF 分布上。使用 DAPA-HF、EMPEROR-Reduced、EMPEROR-Preserved 和 DELIVER 试验中的估计事件率计算 3 年复合恶化 HF 事件和心血管死亡的治疗人数，并将其投射到适用人群上。在所有 LVEF 中，预计将有 4932.9 万（95%置信区间 [CI] 4388.2 万至 5492.9 万）HF 患者符合 SGLT-2 抑制剂的条件，包括 LVEF≤40%的 2565.1 万（95%CI 2281.8 万至 2856.3 万）和 LVEF>40%的 2367.8 万（95%CI 2106.3 万至 2636.6 万）。在 LVEF<40%的患者中，预计 SGLT-2 抑制剂的最佳实施将在 3 年内预防/延迟 451.2011（95%CI 401.3686 至 502.4232）至 598.6943（95%CI 532.5721 至 666.604）总恶化 HF 事件和心血管死亡。在 LVEF>40%的患者中，还将预防/延迟另外 210.2606（95%CI 187.0394 至 234.1301）至 255.7224（95%CI 227.4804 至 284.7528）总恶化 HF 事件和心血管死亡。在所有符合条件的 HF 患者中，无论 LVEF 如何，预计在这段时间内将预防/延迟 706.9235（95%CI 628.8490 至 787.1760）至 808.9549（95%CI 719.6115 至 900.7905）总恶化 HF 事件和心血管死亡。
在 HF 中全面实施 SGLT-2 抑制剂，预计将在 3 年内预防/延迟约 700 万至 800 万例恶化 HF 事件和心血管死亡。
