Real-world use of sodium-glucose co-transporter 2 inhibitors in patients with heart failure and reduced ejection fraction: Data from the Swedish Heart Failure Registry

Aims: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce mortality/morbidity in heart failure (HF). We explored the implementation of SGLT2i over time, and patient characteristics associated with their use, in a large, nationwide population with HF with reduced ejection fraction (HFrEF). Methods and results: Patients with HFrEF (EF < 40%), no type1 diabetes, estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73m2 and/or on dialysis, registered in the Swedish HF Registry between 1-November-2020 and 5-August-2022 were included. Independent predictors of use were investigated by multivariable logistic regressions. Of 8192 patients, 37% received SGLT2i. Use increased overall from 20.5% to 59.0% over time, from 46.2% and 12.5% to 69.8% and 55.4% in patients with and without type 2 diabetes (T2DM), from 14.7% and 22.3% to 58.0% and 59.8% in eGFR<60 vs. ≥60 mL/min/1.73m2 , from 21.6% and 18.9% to 61.6% and 52.0% in males vs. females, from 24.2% and 18.0% to 60.8% and 57.7% in patients with vs. without recent HF hospitalization, from 26.1% and 19.8% to 54.7% and 59.6% in in- vs. out-patient, and from 20.2% and 21.2% to 59.2% and 58.7% in those with HF duration < vs ≥6 months, respectively. Important characteristics associated with SGLT2i use were male sex, recent HF hospitalization, specialized HF follow-up, lower EF, T2DM, higher education level, use of other HF/cardiovascular interventions. Older age, higher blood pressure, atrial fibrillation and anemia were associated with less use. Discontinuation rate at 6 and 12 months was 13.1% and 20.0%, respectively. Conclusions: Use of SGLT2i increased 3-fold over 2 years. Although this indicates a more rapid translation of trials results and guidelines into clinical practice compared to previous HF drugs, further efforts are advocated to complete the implementation process while avoiding inequities across different patients' subgroups and discontinuations.