Uptake of SGLT2i and Outcomes in Patients with Diabetes and Heart Failure: A Population-Based Cohort and a Specialized Clinic Cohort.

Autor: Gagnon LR; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Hazra D; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Perera K; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Wang K; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Kashyap N; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Sadasivan C; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Youngson E; The Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU), Alberta, Canada; Provincial Research Data Services, Alberta Health Services, College Plaza 1702, 8215 112 St NW Edmonton, AB T6G 2C8, Canada., Chu L; The Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU), Alberta, Canada; Provincial Research Data Services, Alberta Health Services, College Plaza 1702, 8215 112 St NW Edmonton, AB T6G 2C8, Canada., Dover DC; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada., Kaul P; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada., Simpson S; Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 2-35 Medical Sciences Building, Edmonton, AB T6G 2H1, Canada., Bello A; Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada., McAlister FA; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; The Alberta Strategy for Patient Oriented Research Support Unit (AbSPORU), Alberta, Canada., Oudit GY; Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address: gavin.oudit@ualberta.ca.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2024 Aug; Vol. 274, pp. 11-22. Date of Electronic Publication: 2024 Apr 25.
DOI: 10.1016/j.ahj.2024.04.007
Abstrakt: Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective in adults with diabetes mellitus (DM) and heart failure (HF) based on randomized clinical trials. We compared SGLT2 inhibitor uptake and outcomes in two cohorts: a population-based cohort of all adults with DM and HF in Alberta, Canada and a specialized heart function clinic (HFC) cohort.
Methods: The population-based cohort was derived from linked provincial healthcare datasets. The specialized clinic cohort was created by chart review of consecutive patients prospectively enrolled in the HFC between February 2018 and August 2022. We examined the association between SGLT2 inhibitor use (modeled as a time-varying covariate) and all-cause mortality or deaths/cardiovascular hospitalizations.
Results: Of the 4,885 individuals from the population-based cohort, 64.2% met the eligibility criteria of the trials proving the effectiveness of SGLT2 inhibitors. Utilization of SGLT2 inhibitors increased from 1.2% in 2017 to 26.4% by January 2022. In comparison, of the 530 patients followed in the HFC, SGLT2 inhibitor use increased from 9.8% in 2019 to 49.1 % by March 2022. SGLT2 inhibitor use in the population-based cohort was associated with fewer all-cause mortality (aHR 0.51, 95%CI 0.41-0.63) and deaths/cardiovascular hospitalizations (aHR 0.65, 95%CI 0.54-0.77). However, SGLT2 inhibitor usage rates were far lower in HF patients without DM (3.5% by March 2022 in the HFC cohort).
Conclusions: Despite robust randomized trial evidence of clinical benefit, the uptake of SGLT2 inhibitors in patients with HF and DM remains low, even in the specialized HFC. Clinical care strategies are needed to enhance the use of SGLT2 inhibitors and improve implementation.
Competing Interests: Disclosure The authors had no relevant conflicts of interest to disclosure.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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