Abstract
Purpose
The benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and type 2 diabetes mellitus (T2DM) has been unequivocally proven in randomized, controlled trials. However, real-world evidence assessing the implementation of SGLT2i in clinical practice and their benefit in HF outside of highly selected study populations is limited.
Methods
Patients with HF and T2DM admitted to the cardiology ward of the Medical University of Vienna between 01/2014 and 04/2020 were included in the present analysis. All first-time prescriptions of SGLT2i were identified. The outcome of interest was cardiovascular mortality. The median follow-up time was 2.3 years.
Results
Out of 812 patients with T2DM and HF (median age 70.4 [IQR 62.4–76.9] years; 70.3% males), 17.3% received an SGLT2i. The frequency of SGLT2i prescriptions significantly increased over the past 6 years (+ 36.6%, p < 0.001). In propensity score–adjusted pairwise analyses, SGLT2i treatment was inversely associated with long-term cardiovascular mortality in patients with HFrEF presenting with an adjusted HR of 0.33 (95%CI: 0.13–0.86; p = 0.024).
Conclusion
Despite large outcome trials showing a cardiovascular benefit, SGLT2i remain underutilized in clinical practice in patients with T2DM and HF. National and European Medical Agency remuneration regulations would allow more patients at high risk to receive these cardiovascular protective drugs. Most importantly, an SGLT2i therapy was associated with a survival benefit in patients with HFrEF.
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Data Availability
Data will be provided upon request.
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AN, PS, and FH contributed to the conception or design of the work. FH, AH, RS, and UP contributed to the acquisition, analysis, or interpretation of data for the work. FH drafted the manuscript. AN, NK, LK, BR, and CH critically revised the manuscript. All gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.
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This article does not contain any studies with human participants performed by any of the authors.
Due to the observational character of the study, patient informed consent was not required.
The study protocol complies with the Declaration of Helsinki and was approved by the local ethics committee of the Medical University of Vienna (EK 2267/2019).
Conflict of Interest
Felix Hofer: none.
Niema Kazem: none.
Bernhard Richter: none.
Ulrike Pailer: none.
Ronny Schweitzer: none.
Andreas Hammer: none.
Lorenz Koller: none.
Christian Hengstenberg: none.
Patrick Sulzgruber: grants from Daiichi Sankyo, grants from AstraZeneca, and grants from Boehringer Ingelheim outside the submitted work.
Alexander Niessner: personal fees from Bayer, personal fees from BMS, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Daiichi Sankyo, and personal fees from Pfizer outside the submitted work.
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Hofer, F., Kazem, N., Richter, B. et al. Prescription Patterns of Sodium-Glucose Cotransporter 2 Inhibitors and Cardiovascular Outcomes in Patients with Diabetes Mellitus and Heart Failure. Cardiovasc Drugs Ther 36, 497–504 (2022). https://doi.org/10.1007/s10557-021-07234-7
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DOI: https://doi.org/10.1007/s10557-021-07234-7