El Rafei Abdelghani, Gosch Kensey, Manning Evan S, Ghajar Alireza, Raghavan Sridharan, Maddox Thomas M, Peterson Pamela N, Fleming Lisa, Arnold Suzanne V, Chan Paul S, Greene Stephen J, Fonarow Gregg C, Jones Philip G, Allen Larry A, Hess Paul L
Division of Cardiology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora.
Division of Cardiology, Department of Medicine, St Luke's Mid America, Kansas City, Missouri.
JAMA Cardiol. 2025 Jul 9. doi: 10.1001/jamacardio.2025.2145.
Sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy reduces risk of heart failure (HF) events and cardiovascular death among individuals with HF. Trends of SGLT2i use in cardiovascular ambulatory care in the US remain unknown.
To evaluate the rate of SGLT2i use among patients with HF in the cardiovascular ambulatory care setting.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study conducted from July 1, 2019, through June 30, 2023. Included for analysis were patients with HF enrolled in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry, a national ambulatory cardiovascular care quality improvement registry. Study data were analyzed from February 15, 2024, through January 15, 2025.
Patient-level and practice-level prescription of SGLT2i therapy.
Of 759 915 patients (mean [SD] age, 70 [14] years; 359 270 women [47.3%]; 49 252 Black individuals [14.6%]; 278 303 White individuals [82.7%]) with HF at 191 US sites, 76 927 (10.1%) were prescribed SGLT2i. Among patients with available ejection fraction (EF) data, 20 544 (17.9%) with HF with reduced EF (HFrEF) and 36 615 (8.9%) with HF with mildly reduced EF (HFmrEF) or HF with preserved EF (HFpEF) were prescribed SGLT2i. Rates of SGLT2i use for all patients with HF increased from 4.6% in the third quarter of 2019 to 16.2% in the second quarter of 2023, from 5.1% to 28.5% for those with HFrEF, and from 4.5% to 12.8% for those with HFmrEF or HFpEF (P for trend <.001). SGLT2i was less commonly used for older persons (IQR age, 80 years vs 63 years; OR, 0.76; 95% CI, 0.75-0.77), female sex (OR, 0.79; 95% CI, 0.77-0.81), and higher systolic blood pressure (OR, 0.78; 95% CI, 0.77-0.79), whereas history of type 2 diabetes was associated with markedly higher use (OR, 3.21; 95% CI, 3.15-3.28). After adjustment for patient- and practice-level characteristics, significant variation in SGLT2i use across sites was present (90th vs 10th percentile risk practice, adjusted OR, 4.40; 95% CI, 3.76-5.52).
Although this study found that SGLT2i use had increased among ambulatory patients with HF during the study period, the majority of eligible patients did not receive this therapy. Older age, female sex, and higher blood pressures were associated with lower SGLT2i use with significant unexplained variation in use across practices. Systematic efforts to improve SGLT2i therapy use are warranted.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）疗法可降低心力衰竭（HF）患者发生心力衰竭事件和心血管死亡的风险。在美国心血管门诊护理中SGLT2i的使用趋势尚不清楚。
评估在心血管门诊护理环境中HF患者使用SGLT2i的比例。
设计、设置和参与者：这是一项回顾性队列研究，时间从2019年7月1日至2023年6月30日。纳入分析的是参加国家心血管数据注册库（NCDR）实践创新与临床卓越（PINNACLE）注册库的HF患者，该注册库是一个全国性的门诊心血管护理质量改进注册库。研究数据于2024年2月15日至2025年1月15日进行分析。
SGLT2i治疗的患者层面和医疗机构层面的处方情况。
在美国191个医疗机构的759915例HF患者（平均[标准差]年龄为70[14]岁；359270例女性[47.3%]；49252例黑人个体[14.6%]；278303例白人个体[82.7%]）中，76927例（10.1%）被处方使用SGLT2i。在有可用射血分数（EF）数据的患者中，20544例（17.9%）射血分数降低的心力衰竭（HFrEF）患者以及36615例（8.9%）射血分数轻度降低的心力衰竭（HFmrEF）或射血分数保留的心力衰竭（HFpEF）患者被处方使用SGLT2i。所有HF患者的SGLT2i使用率从2019年第三季度的4.6%增至2023年第二季度的16.2%，HFrEF患者从5.1%增至28.5%，HFmrEF或HFpEF患者从4.5%增至12.8%（趋势P<0.001）。SGLT2i在老年人（四分位间距年龄为80岁对63岁；比值比，0.76；95%置信区间，0.75 - 0.77）、女性（比值比，0.79；95%置信区间，0.77 - 0.81）以及收缩压较高者（比值比，0.78；95%置信区间，0.77 - 0.79）中使用较少，而2型糖尿病病史与显著更高的使用率相关（比值比，3.21；95%置信区间, 3.15 - 3.28）。在对患者和医疗机构层面特征进行调整后，各医疗机构间SGLT2i的使用存在显著差异（第90百分位数风险医疗机构与第10百分位数风险医疗机构相比，调整后比值比，4.40；95%置信区间，3.76 - 5.52）。
尽管本研究发现研究期间门诊HF患者中SGLT2i的使用有所增加，但大多数符合条件的患者未接受该治疗。年龄较大、女性以及血压较高与SGLT2i使用较少相关，且各医疗机构间的使用存在显著的无法解释的差异。有必要系统地努力改善SGLT2i疗法的使用情况。
