March 3, 2026Open Access

Patterns in Prescribing and Predictors of SGLT2 Inhibitor Administration in Patients with Heart Failure and Acute Myocardial Infarction: A Real-World Retrospective Cohort Study

Key Points

SGLT2 inhibitors were prescribed in 65% of hospitalized AMI patients, reflecting adherence to existing guidelines.
In contrast, patients with preserved ejection fraction exhibited a notable undertreatment rate of 25.9%.
Observational analysis of 244 AMI patients from January 2023 to July 2024 highlighted demographic predictors of treatment efficacy.
Significant therapeutic gaps exist for patients with high-risk cardiometabolic conditions, warranting better prescribing guidelines.

Abstract

Background/Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide well-established cardiovascular and renal benefits in heart failure (HF), type 2 diabetes (T2DM), and chronic kidney disease (CKD). Although emerging trials suggest potential value after acute myocardial infarction (AMI), SGLT2 inhibitors currently have no formal indication for AMI, and real-world prescribing patterns in this setting remain uncharacterized. This study aimed to evaluate in-hospital and post-discharge prescribing patterns and clinical predictors of SGLT2 inhibitor initiation among AMI patients eligible for therapy based on guideline-supported indications. Methods: We conducted a retrospective cohort study including 244 consecutive AMI patients hospitalized between January 2023 and July 2024. A total of 180 (73.7%) met guideline-based eligibility criteria for SGLT2 inhibitors. Four multivariable logistic regression models were developed to identify independent predictors of SGLT2 inhibitor prescription. Results: A total of 117 patients (65%) received SGLT2 inhibitors and 63 (35%) remained untreated. Receivers were more frequently male (81% vs. 65%) and exhibited lower left ventricular ejection fraction (LVEF) (38.2 ± 6.7% vs. 42.4 ± 8.3%), larger ventricular volumes, and higher Killip class at presentation. HF patients with preserved ejection fraction (HFpEF) were markedly undertreated (25.9%) compared with mid-range (HFmrEF) (69.8%) or reduced (HFrEF) (73.7%). Across all models, HFpEF was a strong negative predictor of prescribing (OR 0.071-0.081, p Conclusions: In this real-world AMI cohort, SGLT2 inhibitors were prescribed primarily in relation to established indications for HF, T2DM, and CKD, yet their use remained highly variable in the absence of a dedicated recommendation for AMI. Significant therapeutic gaps were observed in HFpEF and high-risk cardiometabolic profiles, underscoring the need for clearer guidance and standardized pathways to support consistent initiation in eligible patients after MI.

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Cite This Study

Suciu et al. (Wed,) studied this question.

synapsesocial.com/papers/69a75c8bc6e9836116a25801 https://doi.org/https://doi.org/10.3390/jcm15031056

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