Real-World Data on Early Initiation of Sodium-Glucose Co-Transporter-2 Inhibitors in Newly Diagnosed HFrEF

Abstract Aims 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 2 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 a1-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. SGLT2i 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). SGLT2i users vs. non-users had a lower risk of 1-year all-cause mortality (HR, 95%CI=0.75, 0.69 to 0.83), all-cause hospitalizations (HR, 95%CI=0.86, 0.83 to 0.91), and emergency department visits (HR, 95%CI=0.91, 0.86 to 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.