Among 1,081 patients with heart failure, 57.9% received an SGLT2i, with lower use observed in those with preserved ejection fraction (aOR 0.30) and advanced chronic kidney disease.
Cohort (n=1,081)
Yes
Real-world data from Saudi Arabia shows SGLT2i utilization in heart failure is 57.9%, with significant under-prescribing in HFpEF and advanced CKD.
Sodium–glucose cotransporter-2 inhibitors (SGLT2i) are recommended as foundational therapy for patients with heart failure (HF) across all ejection fractions; however, real-world adoption remains inconsistent, and data from Middle Eastern health systems are limited. This study aimed to assess real-world utilization of SGLT2i among patients with HF in Saudi Arabia and to identify clinical factors associated with prescribing and outcomes. We conducted a multicenter retrospective cohort study of adult patients with HF receiving longitudinal care at tertiary cardiac centers between January 2016 and December 2024 in Saudi Arabia. HF phenotypes included reduced, mildly reduced, preserved, and improved ejection fraction. The primary outcome was SGLT2i use during follow-up. Multivariable logistic regression identified factors associated with prescribing. Exploratory outcomes included HF hospitalization and all-cause mortality. Among 1081 patients with HF (median age 66 years IQR 56–76; 50.8% women), 626 (57.9%) received an SGLT2i. Utilization uptake increased over time but was lower in HF with preserved versus reduced ejection fraction (adjusted odds ratio aOR 0.30; 95% CI 0.20–0.43). Diabetes mellitus (aOR 2.29; 95% CI 1.60–3.29) and greater baseline guideline-directed medical therapy optimization (aOR per additional class 1.31; 95% CI 1.13–1.51) were independently associated with use, whereas advanced chronic kidney disease (eGFR < 30 ml/min/1.73 m 2 ) was associated with lower prescribing (aOR 0.26; 95% CI 0.15–0.44). Exploratory analyses suggested lower rates of HF hospitalization and all-cause mortality among SGLT2i users; however, these findings are associative and should be interpreted cautiously. In this real-world cohort, SGLT2i use was heterogeneous and influenced by HF phenotype, renal function, comorbidity burden, and baseline therapy, highlighting persistent gaps in evidence-based HF care.
Alfehaid et al. (Sat,) conducted a cohort in Heart Failure (n=1,081). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. No SGLT2i was evaluated on SGLT2i use during follow-up. Among 1,081 patients with heart failure, 57.9% received an SGLT2i, with lower use observed in those with preserved ejection fraction (aOR 0.30) and advanced chronic kidney disease.