Abstract
INTRODUCTION: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) improve outcomes in patients with heart failure (HF) and are recommended to be initiated in the 6 weeks following an HF hospitalization. We aimed to explore prescription rates and clinical benefits of SGLT2is among patients with newly diagnosed HF and reduced ejection fraction (HFrEF) in real-world practice. METHODS: We conducted a retrospective analysis using the TriNetX Global Collaborative research network. Patients with HFrEF who experienced their first HF hospitalization between September 2021 and December 2023 were identified and were categorized into two groups based on the initiation of SGLT2is within 6 weeks following HF hospitalization. After using propensity score matching to baseline characteristics, Cox hazard ratios (HRs) were calculated to compare outcomes over a 1-year period. RESULTS: Among the identified 70 042 patients with HFrEF, 21.3% were initiated on SGLT2is within 6 weeks following their first HF hospitalization. Sodium-glucose cotransporter-2 inhibitor users were younger, more likely to be male, and had a higher prevalence of diabetes, compared with SGLT2i non-users. After matching, 14 670 matched pairs were created (mean age 64 ± 17 years; 41.6% female; 20% Black). Sodium-glucose cotransporter-2 inhibitor users vs non-users had a lower risk of 1-year all-cause mortality [HR, 95% confidence interval (CI) = 0.75, 0.69-0.83], all-cause hospitalizations (HR, 95% CI = 0.86, 0.83-0.91), and emergency department visits (HR, 95% CI = 0.91, 0.86-0.96). CONCLUSION: In this large multinational real-world data of patients with HFrEF, the prescription rate for SGLT2is within 6 weeks after the first HF hospitalization remained low. However, SGLT2i initiation was associated with improved outcomes, underscoring the importance of guideline-recommended early use.