2013-2021 年伴有和不伴有 T2DM 的 HFrEF 和 HFpEF 患者中 SGLT2 抑制剂的处方趋势。

Prescribing trends of SGLT2 inhibitors among HFrEF and HFpEF patients with and without T2DM, 2013-2021.

机构信息

Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA.

Department of Pharmacy, Jersey Shore University Medical Center, Neptune, NJ, USA.

出版信息

BMC Cardiovasc Disord. 2024 May 30;24(1):285. doi: 10.1186/s12872-024-03961-5.

BACKGROUND

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for treatment of heart failure (HF), regardless of type 2 diabetes (T2DM) status. However, limited data exist on SGLT2i prescribing in HF patients without T2DM or across HF subtypes.

METHODS

This was a serial, cross-sectional study of US MarketScan commercial and Medicare claims (2013-2021). Prevalence of SGLT2i was calculated by calendar year among HFrEF and HFpEF patients and stratified by T2DM status.

RESULTS

Among 218,066 HFrEF patients [mean (SD): 54.9 (8.92) years; 66.4% male], the prevalence of SGLT2i use increased from 0.3 to 18.6%, while among 150,437 HFpEF patients [56.5 (7.77) years; 47.6% male], it rose from 0.5 to 9.9%. These increases were driven by the subgroup with comorbid T2DM. SGLT2i prevalence use ratios among patients with T2DM compared to those without decreased from > 100 in 2018 to 3.8 in 2021 among HFrEF patients, and from 83.1 in 2018 to 17.5 in 2021, coinciding with the publication of landmark trials and corresponding changes in clinical guidelines.

CONCLUSIONS

SGLT2i use rose rapidly following changes in guidelines but remained low among those without T2DM. By the end of the study, approximately 1 in 3 HFrEF and 1 in 5 HFpEF patients with T2DM were using an SGLT2i, compared to only 1 in 11 HFrEF and 1 in 85 HFpEF patients without T2DM. Future work identifying barriers with the uptake of GDMT, including SGLT2i, among HF patients is needed.

背景

钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）被推荐用于心力衰竭（HF）的治疗，无论患者是否患有 2 型糖尿病（T2DM）。然而，HF 患者中 SGLT2i 的处方数据有限，且缺乏对 T2DM 患者和 HF 亚组患者的研究。

方法

这是一项在美国 MarketScan 商业和医疗保险索赔数据（2013-2021 年）中进行的连续、横断面研究。根据 T2DM 状态对 HFrEF 和 HFpEF 患者的 SGLT2i 使用率进行了按年计算。

结果

在 218066 例 HFrEF 患者（平均[标准差]：54.9[8.92]岁；66.4%为男性）中，SGLT2i 的使用率从 0.3%增加到 18.6%，而在 150437 例 HFpEF 患者（56.5[7.77]岁；47.6%为男性）中，SGLT2i 的使用率从 0.5%增加到 9.9%。这些增加主要是由于患有合并 T2DM 的亚组患者所致。与无 T2DM 患者相比，HFrEF 患者中有 T2DM 患者的 SGLT2i 使用率比值从 2018 年的>100 下降到 2021 年的 3.8，而 HFpEF 患者的比值从 2018 年的 83.1 下降到 2021 年的 17.5，这与标志性试验的发表和临床指南的相应变化相吻合。

结论

随着指南的改变，SGLT2i 的使用迅速增加，但在无 T2DM 的患者中仍然较低。研究结束时，约有 1/3 的 HFrEF 和 1/5 的 HFpEF 合并 T2DM 患者在使用 SGLT2i，而无 T2DM 的患者中只有 1/11 的 HFrEF 和 1/85 的 HFpEF 患者在使用 SGLT2i。需要进一步研究以确定 HF 患者在接受 GDMT（包括 SGLT2i）治疗方面存在的障碍。