Key result
Higher social vulnerability is linked to ~4% lower odds of SGLT2i initiation after heart failure hospitalization.
Why the study?
Social determinants of health contribute to inequities in HF management, yet the joint influence of age, insurance status, and social vulnerability index on SGLT2i initiation following new-onset HF remained poorly understood.
Do social vulnerability index, age, and insurance status influence SGLT2 inhibitor initiation following hospitalization for new-onset heart failure?
Cohort (n=389,986)
Yes
Do social vulnerability index, age, and insurance status influence SGLT2 inhibitor initiation following hospitalization for new-onset heart failure?
In patients hospitalized with new-onset heart failure, SGLT2i initiation remains low (20.9%) and is driven predominantly by younger age and insurance type alongside a persistent disadvantage in socially vulnerable communities.
Answers are grounded in this paper and cite their sources.
Disparities in SGLT2i initiation by social vulnerability and insurance may limit equitable HF care; hypothesis-generating for targeted interventions.
BACKGROUND: Social determinants of health contribute to inequities in heart failure (HF) management, yet how age, insurance status, and social vulnerability index (SVI) jointly influence sodium-glucose cotransporter 2 inhibitor (SGLT2i) use remains poorly understood. OBJECTIVE: To evaluate how SVI and key demographic and system-level factors impact SGLT2i initiation following new-onset HF. METHODS: This retrospective cohort study used the Epic Cosmos, a national, de-identified electronic health record repository. Adults aged ≥18 years hospitalized with a new HF diagnosis between 2021 and 2024 were included, excluding those with prior SGLT2i use, dialysis-dependent kidney disease, or hospice enrollment. SVI was categorized into quartiles from least vulnerable (Q1) to most vulnerable (Q4). The primary outcome was SGLT2i initiation following index HF hospitalization stratified by SVI, age, and insurance types. Secondary outcomes included crude and age-adjusted mortality. RESULTS: Among 389,986 patients hospitalized with new HF, 81,387 patients (20.9%) were started on SGLT2i. Higher social vulnerability was inversely associated with initiation (Q4 vs Q1 adjusted OR 0.96, 95% CI 0.93-0.98). Younger age was the strongest predictor of initiation (<45 vs 65-74 years: adjusted OR 1.53, 95% CI 1.48-1.59). Commercial insurance was independently associated with higher initiation odds (adjusted OR 1.20, 95% CI 1.18-1.22; p<0.001), as was Medicaid beneficiaries (adjusted OR 1.06, 95% CI 1.02-1.11; p=0.006). CONCLUSION: In patients with new HF diagnosis, a persistent disadvantage in SGLT2i initiation exists in high-SVI communities. Age and insurance, not social vulnerability alone, are the dominant determinants, highlighting the need for targeted strategies in older adults and payer-level reform.
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Shukla et al. (2026) conducted a cohort in New-onset heart failure (n=389,986). Higher social vulnerability (SVI Quartile 4), age, and insurance status vs. Least socially vulnerable (SVI Quartile 1), older age (65-74 years), and reference insurance status was evaluated on SGLT2i initiation following index heart failure hospitalization stratified by social vulnerability index, age, and insurance types (OR 0.96, 95% CI 0.93-0.98). Higher social vulnerability (Q4 vs Q1: aOR 0.96, 95% CI 0.93-0.98), younger age (<45 vs 65-74y: aOR 1.53), and commercial insurance (aOR 1.20) significantly determined SGLT2i initiation.
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