Data from previous clinical trials have established considerable cardiovascular benefit with the use of SGLT2 inhibitors in patients with T2DM and heart failure (HF) regardless of ejection fraction; however, there are inadequate data assessing real-world prescription and practice patterns of SGLT2 inhibitors.
In a recent study published in the Journal of the American College of Cardiology Heart Failure, researchers utilized data from the nationwide Veterans Affairs healthcare system and sought to examine the utilization rates and facility-level variation in the use among patients with established atherosclerotic cardiovascular disease (ASCVD), HF, and T2DM.
Between January 1, 2020, and December 31, 2020, the researchers reviewed data from patients with established ASCVD, HF, and T2DM under the care of a primary care provider. For this study, the researchers evaluated the use of SGLT2 inhibitors and the facility-level variation in their use computed using median rate ratios, a measure of likelihood that two random facilities differ in using SGLT2 inhibitors.
The results revealed that across 130 Veterans Affairs facilities, including 105,799 patients with ASCVD, HF, and T2DM, 14.6% received SGLT2 inhibitors. Patients receiving SGLT2 inhibitors were younger men with higher hemoglobin A1c and estimated glomerular filtration rate and were more likely to have HF with reduced ejection fraction and ischemic heart disease. At two random facilities, there was a noteworthy facility-level variation of SGLT2 inhibitor use, with an adjusted median rate ratio of 1.55 (95% CI: 1.46-1.64), indicating a 55% residual difference in SGLT2 inhibitor use among comparable patients with ASCVD, HF, and T2DM receiving care.
The authors wrote, “In these analyses, we have demonstrated that in patients with high-risk comorbidities associated with a well-established SGLT2 inhibitor benefit (ASCVD, T2DM, and HF), only 15% were treated with SGLT2 inhibitors.”
Based on their findings, the authors concluded that the utilization rates of SGLT2 inhibitors are low in patients with ASCVD, HF, and T2DM, with high residual facility-level variation. The findings suggest that there is a need to enhance SGLT2 inhibitor use to thwart future adverse cardiovascular events.
The authors wrote, “This study serves as a baseline and identifies an opportunity to intensify efforts to improve the utilization of preventive therapies in an extremely high-risk patient phenotype, such as older adults, those other than non-Hispanic white patients, those with lower eGFR, and those with PAD [peripheral arterial disease] or ischemic cerebrovascular disease.”
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