Sawalha Khalid, Fancher Andrew J, Al'Aref Subhi, Lopez Candales Angel
Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, USA.
Cardiometabolic Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA.
Cureus. 2025 Apr 5;17(4):e81757. doi: 10.7759/cureus.81757. eCollection 2025 Apr.
Background Sacubitril/valsartan and sodium-glucose transporter 2 inhibitors (SGLT2is) are emerging classes of medications that have become key components of guideline-directed medical therapy for patients with heart failure (HF) with reduced ejection fraction and New York Heart Association class II, III, or IV symptoms. Both sacubitril/valsartan and SGLT2is have demonstrated the ability to improve morbidity and mortality in HF patients. This analysis evaluates current prescribing trends of sacubitril/valsartan and SGLT2is in a safety net hospital setting. Methods In this retrospective study, a chart review was conducted to identify sacubitril/valsartan use, categorized by drug dose and prescriber specialty, at University Health Truman Medical Centers in Kansas City, Missouri, USA, from October 1, 2021, to October 31, 2022. A second chart review similarly identified SGLT2i usage, also categorized by drug dose and prescriber specialty, within the same time frame and healthcare system. Results Of the 769 patients prescribed sacubitril/valsartan, 497 (64.6%) were prescribed the 24 mg/26 mg dose, 193 patients (25.1%) received the 49 mg/51 mg dose, and 79 patients (10.3%) were on the 97 mg/103 mg dose. Cardiologists accounted for only 23.3% of sacubitril/valsartan prescriptions, while ancillary staff, including nurse practitioners, physician assistants, and pharmacists, accounted for the majority (49.8%) of prescriptions. Regarding SGLT2is, 2,287 patients were prescribed these medications: 343 patients were prescribed dapagliflozin (188 at the 5 mg dose and 155 at the 10 mg dose); one patient received ertugliflozin at the 5 mg dose; 634 patients were prescribed canagliflozin (404 at the 100 mg dose, 173 at the 300 mg dose, 40 at the 50 mg dose with metformin combination, and 17 at the 150 mg dose with metformin combination); and 1,309 patients were prescribed empagliflozin (972 at the 10 mg dose, 333 at the 25 mg dose, two at the 5 mg dose with metformin combination, and two at the 12.5 mg dose with metformin combination). Cardiologists prescribed only 10.0% of SGLT2is, while internal/family medicine physicians accounted for the majority (52.3%) of prescriptions. Conclusions Robust evidence supports the use of sacubitril/valsartan and SGLT2is in HF, with both also proving effective for treating other diseases commonly coexisting with HF. The observed dosing patterns and distribution of prescribers reflect the broad utility of these novel therapeutics in diverse clinical settings.
沙库巴曲缬沙坦和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是新兴的药物类别，已成为射血分数降低且有纽约心脏协会II、III或IV级症状的心力衰竭（HF）患者指南导向药物治疗的关键组成部分。沙库巴曲缬沙坦和SGLT2i均已证明有能力改善HF患者的发病率和死亡率。本分析评估了在安全网医院环境中沙库巴曲缬沙坦和SGLT2i的当前处方趋势。方法：在这项回顾性研究中，于2021年10月1日至2022年10月31日在美国密苏里州堪萨斯城的大学健康杜鲁门医疗中心进行了一项图表审查，以确定按药物剂量和开处方者专业分类的沙库巴曲缬沙坦使用情况。在同一时间框架和医疗系统内，进行了第二次图表审查，同样确定了按药物剂量和开处方者专业分类的SGLT2i使用情况。结果：在769例开具沙库巴曲缬沙坦的患者中，497例（64.6%）开具的是24mg/26mg剂量，193例患者（25.1%）接受的是49mg/51mg剂量，79例患者（10.3%）使用的是97mg/103mg剂量。心脏病专家开具的沙库巴曲缬沙坦处方仅占23.3%，而包括执业护士、医师助理和药剂师在内的辅助人员开具的处方占大多数（49.8%）。关于SGLT2i，有2287例患者开具了这些药物：343例患者开具了达格列净（188例为5mg剂量，155例为10mg剂量）；1例患者接受了5mg剂量的依格列净；634例患者开具了卡格列净（404例为100mg剂量，173例为300mg剂量，40例为50mg剂量与二甲双胍联合使用，17例为150mg剂量与二甲双胍联合使用）；1309例患者开具了恩格列净（972例为10mg剂量，333例为25mg剂量，2例为与二甲双胍联合使用的5mg剂量，2例为与二甲双胍联合使用的12.5mg剂量）。心脏病专家开具的SGLT2i仅占10.0%；而内科/家庭医学医生开具的处方占大多数（52.3%）。结论：有力证据支持在HF中使用沙库巴曲缬沙坦和SGLT2i，二者还被证明对治疗通常与HF并存的其他疾病有效。观察到的给药模式和开处方者分布反映了这些新型疗法在不同临床环境中的广泛应用。
