In-hospital initiation of sodium-glucose cotransporter-2 inhibitors in patients with heart failure and reduced ejection fraction: 90-day prescription patterns and clinical implications.

Autor: Burgos LM; Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina. Electronic address: lburgos@icba.com.ar., Ballari FN; Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina., Spaccavento A; Clinical Cardiology Department. Instituto Cardiovascular de Buenos Aires. Argentina., Ricciardi B; Clinical Cardiology Department. Instituto Cardiovascular de Buenos Aires. Argentina., Suárez LL; Clinical Cardiology Department. Instituto Cardiovascular de Buenos Aires. Argentina., Baro Vila RC; Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina., De Bortoli MA; Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina., Conde D; Clinical Cardiology Department. Instituto Cardiovascular de Buenos Aires. Argentina., Diez M; Heart Failure, Pulmonary Hypertension and Heart Transplant Division. Instituto Cardiovascular de Buenos Aires Argentina.
Jazyk: angličtina
Zdroj: Current problems in cardiology [Curr Probl Cardiol] 2024 Oct; Vol. 49 (10), pp. 102779. Date of Electronic Publication: 2024 Jul 31.
DOI: 10.1016/j.cpcardiol.2024.102779
Abstrakt: Introduction: 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.
Objectives Primary: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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