Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina.
Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina.
Curr Probl Cardiol. 2024 Oct;49(10):102779. doi: 10.1016/j.cpcardiol.2024.102779. Epub 2024 Jul 31.
Safety and early clinical benefit make sodium-glucose cotransporter-2 inhibitor (SGLT2-i) therapy suitable for in-hospital initiation in patients with heart failure and reduced ejection fraction (HFrEF). Despite randomized controlled trials and guideline recommendations, they are underused, and clinical inertia may play a role.
To assess the impact of initiating SGLT-2i at discharge on 90-day prescription rates in patients with HFrEF during hospitalization for acute heart failure (AHF). Secondary: To evaluate the presence of independent factors associated with prescription, and to explore clinical outcomes at 90 days.
Retrospective analysis of a consecutive prospective single-center cohort. Adult patients hospitalized between January 2021 and September 2022 with a primary diagnosis of AHF and left ventricular ejection fraction (LVEF) <40% were included. The primary outcome was SGLT2-i prescription rate at 90 days, and the exploratory secondary endpoints was the composite of hospitalization or urgent visit for AHF or all-cause mortality at 90 days.
237 patients were included. Mean age was 76±11 years, and mean LVEF was 29±7%. In patients without contraindications, SGLT2 inhibitors (SGLT2-i) were prescribed during hospitalization in 52.3%. At 90 days, the SGLT2-i prescription rate was 94.2% in those with in-hospital initiation and 14.4% in those without. (p<0.001). Independent factor associated with inpatient prescription was lower LVEF, 0.83 (95% CI: 0.77-0.89) for each point. Patients with in-hospital SGLT2-i initiation showed a lower rate of the combined endpoint of all-cause death, HF rehospitalization, or unplanned HF visit at 90 days (44.4% versus 23.9%, p=0.005).
In-hospital initiation of SGLT-2-i was associated with significantly higher prescription rates and lower prevalence in the secondary combined endpoint at 90 days. This study reflects the presence of medical inertia, particularly in patients with higher LVEF, and highlights the hospitalization period as an optimal time to start SGLT2-i.
钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2-i) 的安全性和早期临床获益使其成为射血分数降低的心力衰竭 (HFrEF) 患者住院期间起始治疗的合适选择。尽管有随机对照试验和指南推荐，但 SGLT2-i 的应用仍不足，临床惰性可能起作用。
评估急性心力衰竭 (AHF) 住院期间出院时开始使用 SGLT-2i 对 HFrEF 患者 90 天内处方率的影响。次要目的：评估与处方相关的独立因素的存在，并探讨 90 天的临床结局。
对连续前瞻性单中心队列进行回顾性分析。纳入 2021 年 1 月至 2022 年 9 月期间因 AHF 住院且左心室射血分数 (LVEF) <40%的原发性诊断为 AHF 的成年患者。主要结局为 90 天内 SGLT2-i 处方率，探索性次要终点为 90 天内因 AHF 住院或紧急就诊或全因死亡率的复合终点。
共纳入 237 例患者。平均年龄为 76±11 岁，平均 LVEF 为 29±7%。在无禁忌症的患者中，52.3%的患者在住院期间开具 SGLT2 抑制剂 (SGLT2-i)。90 天时，住院起始 SGLT2-i 处方率为 94.2%，无起始处方者为 14.4%（p<0.001）。与住院期间开具处方相关的独立因素是较低的 LVEF，每降低 1 点，风险比为 0.83（95%CI：0.77-0.89）。住院期间开始使用 SGLT2-i 的患者在 90 天内全因死亡、心力衰竭再住院或计划外心力衰竭就诊的复合终点发生率较低（44.4%比 23.9%，p=0.005）。
住院期间开始使用 SGLT-2-i 与 90 天内处方率显著升高和次要复合终点的发生率降低相关。这项研究反映了存在临床惰性，尤其是在 LVEF 较高的患者中，并强调了住院期间是开始 SGLT2-i 的最佳时机。
