Why the study?
The authors sought to evaluate how many real-world outpatients with CHF meet enrolment criteria from major RCTs to determine the proportion who could potentially benefit from SGLT2i therapy.
What proportion of real-world outpatients with chronic heart failure are eligible for SGLT2 inhibitor therapy based on major trial criteria?
What proportion of real-world outpatients with chronic heart failure are eligible for SGLT2 inhibitor therapy based on major trial criteria?
A high proportion of real-world outpatients with chronic heart failure meet the eligibility criteria for major SGLT2 inhibitor trials, suggesting broad potential applicability of these therapies in clinical practice.
Supports SGLT2i initiation in most real-world HFrEF outpatients; extends RCT generalizability to similar high-risk populations.
AIMS: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been shown to have a relevant role in the prevention of hospitalizations for heart failure and improvement in the life expectancy of patients with diabetes and outpatients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, independently from the presence of type 2 diabetes mellitus (T2DM). The aim of our study was to evaluate in a real-world population the number of outpatients with CHF who meet the enrolment criteria of the main randomized controlled trials (RCT) published in the last 5 years and consequently identify the percentage of patients who could potential benefit from SGLT2i therapy. METHODS AND RESULTS: We retrospectively evaluated all consecutive outpatients referred for CHF. The diagnosis of T2DM was according to the latest European Society of Cardiology Guidelines. Clinical characteristics considered for the enrolment in the RCTs were recorded. We enrolled 515 patients, 384 (75%) of whom had a left ventricular ejection fraction (LVEF) ≤ 40%, 82 (16%) had pre-diabetes, and 187 (36%) had diabetes. Most of the patients with LVEF ≤ 40% met the criteria for the DAPA-HF trial (65%), and this percentage was even higher if the serum level of N-terminal pro-brain natriuretic peptide was not considered. A high percentage of patients with diabetes and LVEF > 40% met the criteria for the DECLARE (39%), CANVAS (47%), and EMPA-REG (30%) trials. Patients meeting the enrolment criteria of RCTs evaluating SGLT2i were also characterized by a high risk of heart failure events during follow-up. CONCLUSIONS: In spite of a low number of patients actually treated with SGLT2i, we observed that a high prevalence of patients with CHF met the clinical characteristics of RCTs that have demonstrated a beneficial effect of SGLT2i.
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Angelini et al. (2021) studied this question.
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