What question did this study set out to answer?

This study aims to evaluate the initiation of SGLT-2 inhibitors after first hospitalization for heart failure and identify predictors of this initiation.

January 10, 2026Open Access

Early initiation of sodium–glucose co-transporter-2 inhibitors in heart failure patients: a nationwide study

Key Result

SGLT-2i initiation after first heart failure hospitalization was only 16.1%, increasing to 28.5% from 2021 to 2023, with significant variability across hospitals (MOR 1.55).

Key Points

This study aims to evaluate the initiation of SGLT-2 inhibitors after first hospitalization for heart failure and identify predictors of this initiation.
Analyzed data from the French National Healthcare Database (2021-2023)
Included patients discharged after their first heart failure hospitalization
Excluded prior SGLT-2i users
Utilized multilevel logistic regression for predictor analysis
Estimated between-hospital variance in SGLT-2i initiation using median odds ratio (MOR)
16.1% of 303,118 patients initiated SGLT-2 inhibitors post-hospitalization
Initiation rates were higher in patients under 75 years (24.3%) compared to older patients (12.4%)
Significant differences in initiation based on sex, diabetes status, LVEF, and presence of chronic kidney disease
Overall initiation rate increased from 4.8% in 2021 to 28.5% in 2023
High between-hospital variance with 25% of hospitals contributing to over half of initiations (MOR 1.55)

Structured PICO

Population

303,118 patients discharged from a first heart failure hospitalization between 2021 and 2023, without prior exposure to SGLT-2 inhibitors.

Intervention

Initiation of sodium-glucose co-transporter-2 inhibitors (SGLT-2i)

Outcome

SGLT-2i initiation after a first heart failure hospitalization

Real-world initiation of SGLT-2 inhibitors following a first heart failure hospitalization in France is increasing but remains suboptimal and highly variable across hospitals.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Introduction While sodium–glucose co-transporter-2 inhibitors (SGLT-2i) have shown substantial benefit in heart failure (HF) across clinical trials and are now a cornerstone of HF guideline-directed medical therapy (GDMT), data on their use in Europe remains scarce. This study aimed to assess SGLT-2i initiation after a first HF hospitalization, identify its predictors, and evaluate between-hospital disparities. Methods Using the French National Healthcare Database (SNDS) between 2021 and 2023, SGLT-2i initiation was assessed in patients discharged from a first HF hospitalization, excluding patients with prior exposure to SGLT-2i. Multilevel logistic regression identified individual- and hospital-level predictors of SGLT-2i initiation and median odds ratio (MOR) estimated between-hospital variance in SGLT-2i initiation. Results Among 303 118 patients, 16.1% initiated SGLT-2is. Initiation rates were higher in patients ≤75 years (24.3% vs. 12.4%), males (19.7% vs. 12.4%), diabetics (18.9% vs. 14.8%), without chronic kidney disease (CKD) (17.4% vs. 11.4%), and with lower left ventricular ejection fraction (LVEF) (40%: 36.1%, 40%–49%: 19.7%, ≥50%: 11.7%, P for trend 0.001). Initiation rose from 4.8% in 2021 to 28.5% in 2023 (P for trend 0.001), with similar trends across subgroups. Positive predictors included male sex, critical care unit stay, diabetes, lower LVEF and background GDMT, while older age and CKD were negative predictors. Between-hospital variance in SGLT-2i initiation was high, with 25% of hospitals sharing more than half of SGLT-2i initiators (MOR 1.55, 95% CI 1.50–1.60). Conclusion In this nationwide study, SGLT-2i initiation increased over the years but remains suboptimal and highly variable across hospitals and patient phenotypes, highlighting opportunities to improve GDMT.