Abdel Jawad Mohammad, Spertus John A, Ikeaba Uchechukwu, Greene Stephen J, Fonarow Gregg C, Chiswell Karen, Chan Paul S
University of Missouri Kansas City's Healthcare Institute for Innovations in Quality, Kansas City.
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
JAMA Cardiol. 2025 Jan 1;10(1):89-94. doi: 10.1001/jamacardio.2024.4489.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are the first therapy shown to improve clinical outcomes for patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) greater than 40%. Nationwide adoption of SGLT2is in the US since publication of the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction (EMPEROR-Preserved) in August 2021 is unknown.
To examine trends and hospital-level variation in SGLT2i adoption.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients with LVEF greater than 40% who were hospitalized for decompensated HF at 1 of 557 sites in the US between July 1, 2021, and September 30, 2023, from the Get With The Guidelines-Heart Failure registry.
Patient-level trends and site-level variation in prescription rates of SGLT2i at hospital discharge. Site-level variation was quantified using the median odds ratio, which describes the average odds that a patient being treated at one vs another randomly selected hospital would receive SGLT2i therapy at discharge.
Of 158 849 patients (median [IQR] age, 76 [66-85] years; 89 816 females [56.5%]), 22 126 eligible patients (13.9%) with HF and an LVEF greater than 40% were prescribed an SGLT2i at hospital discharge. Quarterly prescription rates increased from 4.2% in July to September 2021 to 23.5% in July to September 2023 (P for trend < .001). SGLT2i prescription was more likely among patients with HF with mildly reduced LVEF (41%-49%) than in those with preserved LVEF (≥50%; 5127 of 27 712 patients [18.5%] vs 16 999 of 131 137 patients [13.0%]; absolute standardized difference, 16.7%). After adjustment for patient characteristics, there was a high variance between hospitals in the rate of SGLT2i prescription (median odds ratio, 2.12; 95% CI, 2.02-2.25). Among 518 hospitals with 10 or more eligible discharges, 11 hospitals (2.1%) discharged 50% or more of their patients with an SGLT2i prescription, while 232 (44.8%) discharged fewer than 10% of eligible patients with an SGLT2i prescription.
For patients with HF and an LVEF greater than 40%, discharge prescription of SGLT2is increased from 4.2% to 23.5% during the first 2 years after the EMPEROR-Preserved trial demonstrating treatment benefits; however, these rates varied across US hospitals.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是首个被证明能改善射血分数大于40%的心力衰竭（HF）患者临床结局的治疗方法。自2021年8月《恩格列净治疗射血分数保留的慢性心力衰竭患者的结局试验》（EMPEROR-Preserved）发表以来，SGLT2i在美国的全国性应用情况尚不清楚。
研究SGLT2i应用的趋势和医院层面的差异。
设计、设置和参与者：这项队列研究纳入了2021年7月1日至2023年9月30日期间在美国557个地点之一因失代偿性HF住院、射血分数大于40%的患者，数据来自“遵循指南-心力衰竭”注册库。
出院时SGLT2i处方率的患者层面趋势和医院层面差异。医院层面的差异使用中位数优势比进行量化，该指标描述了在一家医院接受治疗的患者与在另一家随机选择的医院接受治疗的患者在出院时接受SGLT2i治疗的平均优势。
在158849例患者（年龄中位数[四分位间距]为76[66 - 85]岁；89816例女性[56.5%]）中，22126例符合条件的HF且射血分数大于40%的患者在出院时被开具了SGLT2i处方。季度处方率从2021年7月至9月的4.2%增至2023年7月至9月的23.5%（趋势P<0.001）。射血分数轻度降低（41% - 49%）的HF患者比射血分数保留（≥50%）的患者更有可能开具SGLT2i处方（27712例患者中有5127例[18.5%]，131137例患者中有16999例[13.0%]；绝对标准化差异为16.7%）。在对患者特征进行调整后，医院之间SGLT2i处方率存在很大差异（中位数优势比为2.12；95%置信区间为2.02 - 2.25）。在有10次或更多符合条件出院的518家医院中，11家医院（2.1%）出院的患者中有50%或更多开具了SGLT2i处方，而232家医院（44.8%）出院的符合条件患者中开具SGLT2i处方的不到10%。
对于射血分数大于40%的HF患者，在EMPEROR-Preserved试验证明治疗益处后的前两年，SGLT2i的出院处方率从4.2%增至23.5%；然而，这些比率在美国各医院之间存在差异。
