OBJECTIVES: In randomized controlled studies, sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated benefits for patients with heart failure (HF), including those with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Despite clinical guidelines endorsing SGLT2 inhibitors for HF patients, regardless of type 2 diabetes mellitus (T2DM) status, their real-world adoption remains unclear. This study investigates the prescribing patterns of SGLT2 inhibitors within a large academic hospital.

METHODS: The study included patients over age of 18 with HF, who had received care from June 2020 to June 2023. Patients were categorized into four cohorts: HF only, HF with T2DM, HF with chronic kidney disease (CKD), and HF with both CKD and T2DM. The primary endpoint was evaluating SGLT2 inhibitor treatment rates in each cohort. Descriptive analyses assessed baseline characteristic distribution across cohorts.

RESULTS: Among 2,995 HF patients (median age 67 years; 44.7% female), 1,217 (40.6%) had T2DM, and 741 (24.7%) had CKD. SGLT2 inhibitors were prescribed to 27.6% of the HF patients. Specifically, treatment rates were 18.5% for HF only, 43.6% for HF with T2DM, 16.8% for HF with CKD, and 36.7% for HF with both diabetes and CKD. In HFpEF patients, 19.6% received SGLT2 inhibitors, compared to 40.3% in HFrEF patients. Dapagliflozin was the most prescribed SGLT2 inhibitor, followed by empagliflozin.

CONCLUSIONS: Although robust clinical evidence exists on the cardioprotective benefits associated with SGLT2 inhibitor in HF clinical management, this study’s results suggest they remain underutilized in HF patients, particularly among those with additional comorbidities. Future research is needed to investigate the effect of patients’ factors such as age, gender, and comorbidities, as well as physicians’ characteristics and attitude, on the use of SGLT2 inhibitors in HF patients.