Being female (aOR 0.83; 95% CI 0.78-0.87) and living in socioeconomically disadvantaged municipalities were associated with a lower likelihood of SGLT2i initiation for heart failure.
Observational (n=68,426)
Yes
Are socioeconomic factors associated with SGLT2 inhibitor initiation in patients with heart failure?
Women, older patients, and individuals living in socioeconomically disadvantaged municipalities are less likely to be initiated on SGLT2 inhibitors for heart failure, highlighting disparities in the implementation of guideline-directed medical therapy.
Odds Ratio: 0.83 (95% CI 0.78–0.87)
BACKGROUND: This study was aimed at analysing the association between socioeconomic factors and SGLT2 inhibitor (SGLT2i) initiation in patients with heart failure. METHODS: In this retrospective analysis, German health insurance claims data from 2022 to 2023 were used, covering more than 2.8 million individuals. Heart failure was defined using ICD-10-GM codes. Area-based socioeconomic data were obtained from the INKAR database. Associations were assessed using a multilevel logistic regression analysis. RESULTS: In 2023, 90,841 individuals were diagnosed with heart failure. After excluding patients with prior SGLT2i use in 2022 and those with missing data, 68,426 SGLT2i-naive individuals were included in the analysis. A higher likelihood of SGLT2i initiation was associated with newly coded heart failure (adjusted odds ratio (aOR): 2.42, 95% CI 2.29-2.56) and new enrolment in a disease management program for coronary artery disease (aOR: 1.89, 95% CI 1.68-2.12). Being a pensioner (aOR: 0.86, 95% CI 0.78-0.93), having family insurance (aOR: 0.79, 95% CI 0.66-0.95), moving (aOR: 0.80, 95% CI 0.67-0.95), being female (aOR: 0.83, 95% CI 0.78-0.87), and older age (aOR: 0.37, 95% CI 0.18-0.76) were negatively associated. At the municipal level, residing in a higher-income tax municipality (aOR: 1.70, 95% CI 1.37-2.09) was positively related to SGLT2i initiation. These associations were adjusted for other socioeconomic factors, comorbidities, and heart failure medications. CONCLUSIONS: Women and individuals living in socioeconomically disadvantaged municipalities were less likely to receive SGLT2i initiation for heart failure.
Müller et al. (2026) conducted an observational in Heart failure (n=68,426). Socioeconomic factors (e.g., female sex, municipality income) vs. Reference demographic/socioeconomic groups was evaluated on SGLT2i initiation (aOR 0.83, 95% CI 0.78-0.87). Being female (aOR 0.83; 95% CI 0.78-0.87) and living in socioeconomically disadvantaged municipalities were associated with a lower likelihood of SGLT2i initiation for heart failure.