Implementation of sodium-glucose co-transporter 2 inhibitors use in patients with heart failure across the ejection fraction: data from the Swedish heart failure registry

Abstract Aims To assess the implementation of sodium–glucose co-transporter-2 inhibitors (SGLT2i) use in a real-world heart failure (HF) cohort. Methods and Results Patients from the Swedish HF Registry enrolled 01-sep-2022 to 16-dec-2024 were included. Characteristics independently associated with SGLT2i use were investigated by multivariable logistic regression models, in the overall cohort and stratified by ejection fraction (EF). Of 24,578 patients (median ageQ1-Q3:7565-81years, 33% female), 43% had HF with reduced EF(HFrEF), 31% had HF with mildly reduced EF(HFmrEF), and 26% had HF with preserved EF(HFpEF). During the study period, SGLT2i use increased from 78% to 89% in HFrEF, from 54% to 80% in HFmrEF and from 41% to 80% in HFpEF. Independent predictors of SGLT2i use included male sex, HF hospitalization during the past year, impaired kidney function, obesity, higher socioeconomic profile, and beta-blockers use. Follow-up in specialist care was associated with higher use in HFrEF and HFmrEF. Type 2 diabetes (T2DM) was independently associated with use across EF, with a stronger association in HFpEF. Renin–angiotensin–aldosterone system inhibitors were associated with SGLT2i use across the EF spectrum, with stronger associations in HFrEF and HFmrEF, while mineralocorticoid receptor antagonists showed similar associations across EF categories, stronger in HFrEF and HFmrEF. Conclusions SGLT2i were rapidly implemented in clinical practice, with their use reaching ∼90% in HFrEF and approaching a plateau at ∼80% in HFmrEF and HFpEF in December 2024. There is still room for treatment optimization, particularly among women, patients with HFpEF without T2DM, those followed in primary care and with lower socioeconomic status.