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.

中文翻译：

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糖尿病和心力衰竭患者钠-葡萄糖协同转运蛋白 2 抑制剂的处方模式和心血管结局

目的

钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 对射血分数降低 (HFrEF) 和 2 型糖尿病 (T2DM) 的心力衰竭 (HF) 患者的益处已在随机对照试验中得到明确证明。然而，评估 SGLT2i 在临床实践中的实施及其在高度选择的研究人群之外的 HF 中的益处的真实证据是有限的。

方法

本分析包括在 2014 年 1 月至 2020 年 4 月期间入住维也纳医科大学心脏病病房的 HF 和 T2DM 患者。确定了所有 SGLT2i 的首次处方。感兴趣的结果是心血管死亡率。中位随访时间为 2.3 年。

结果

在 812 名 T2DM 和 HF 患者（中位年龄 70.4 [IQR 62.4-76.9] 岁；70.3% 男性）中，17.3% 接受了 SGLT2i。SGLT2i 处方的频率在过去 6 年中显着增加（+ 36.6%，p  < 0.001）。在倾向评分调整的成对分析中，SGLT2i 治疗与 HFrEF 患者的长期心血管死亡率呈负相关，调整后的 HR 为 0.33（95%CI：0.13-0.86；p  = 0.024）。

结论

尽管大型结果试验显示心血管益处，但 SGLT2i 在 T2DM 和 HF 患者的临床实践中仍未得到充分利用。国家和欧洲医疗机构的薪酬法规将允许更多高危患者接受这些心血管保护药物。最重要的是，SGLT2i 治疗与 HFrEF 患者的生存获益相关。