Use of <scp>sodium–glucose</scp> co‐transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus: data from the Swedish Heart Failure Registry

Becher, Peter Moritz; Schrage, Benedikt; Ferrannini, Giulia; Benson, Lina; Butler, Javed; Carrero, Juan Jesús; Cosentino, Francesco; Dahlström, Ulf; Mellbin, Linda; Rosano, Giuseppe; Sinagra, Gianfranco; Stolfo, Davide; Lund, Lars H.; Savarese, Gianluigi

doi:10.1002/ejhf.2131

Cited by 40 publications

(45 citation statements)

References 31 publications

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“…The differential characteristics of patients treated by different care provider types have been described in previous studies. In general, HF patients treated by non-cardiologist have been observed to be older, more often female, with more comorbidities, higher EFs and lower use of HF therapy [2,3,6,11,12,17,18]. These studies reported unadjusted differences between patients treated by cardiologists vs noncardiologists, thus being subject to confounding.…”

Section: Associations Between Patient Characteristics and Type Of Carementioning

confidence: 99%

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Kapelios

Canepa

Benson

et al. 2021

International Journal of Cardiology

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Background: Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown. Methods: In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and outpatient care. Results: Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients overall), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age > 75 years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14-1.27), lower education level (0.71; 0.66-0.76 for university vs. compulsory), valve disease (1.24; 1.18-1.31) and systolic blood pressure (SBP) >120 mmHg (1.05; 1.00-1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74-0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56-0.71), and less frequent specialist follow-up (0.61; 0.57-0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03-1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89-0.97) in non-cardiology vs. cardiology care. Conclusions: In HFrEF, non-cardiology care was independently associated with older ageand lower education. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology care may not be equitable and this may have implications for use of guideline-based care and outcomes.

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Section: Associations Between Patient Characteristics and Type Of Carementioning

confidence: 99%

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Kapelios

Canepa

Benson

et al. 2021

International Journal of Cardiology

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“…Results were consistent across the broad spectrum of cardio‐renal‐metabolic risk, although those with established HF had the greatest absolute benefit 28 . SGLT2 inhibitors were administered to only 376 (5.5%) of 6805 patients with HF and type 2 diabetes included in the SwedeHF Registry with, however, increasing use over time, especially in young patients, with a history of ischaemic disease and normal renal function 29 . Their administration was associated with a 30% reduction of cardiovascular death/first HF hospitalization 29 .…”

Section: Medical Treatmentmentioning

confidence: 69%

“…SGLT2 inhibitors were administered to only 376 (5.5%) of 6805 patients with HF and type 2 diabetes included in the SwedeHF Registry with, however, increasing use over time, especially in young patients, with a history of ischaemic disease and normal renal function 29 . Their administration was associated with a 30% reduction of cardiovascular death/first HF hospitalization 29 . In a pre‐specified biomarker study from DECLARE‐TIMI 58, dapagliflozin reduced the composite risk of cardiovascular death or HF hospitalization irrespective of baseline N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hsTnT) values.…”

Section: Medical Treatmentmentioning

confidence: 99%

June 2021 at a glance: focus on epidemiology, biomarkers and medical treatment

Tomasoni

Adamo

Metra

2021

European J of Heart Fail

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The epidemiology of heart failure (HF) is still unsettled, above all in European countries, because of marked differences in coding and management modalities. To date, most of our data came from analyses of dedicated studies and trials. 1,2 The Heart Failure Association (HFA) Atlas is a novel European data set, developed to provide a contemporary description of HF epidemiology and management. 3,4 The median incidence of HF was 3.2 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years; the median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people and the median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people, annually. A large heterogeneity among different countries both with respect to epidemiology and management was shown. 3 Diagnosis and prognosis Endomyocardial biopsyTreatment of cardiomyopathies and myocarditis remains challenging. [5][6][7] Indications to endomyocardial biopsy needed to be updated accordingly and this issue hosts a consensus document developed by HFA, HF Society of America and Japanese HF Society. 8 Evidence-based medical treatment is still underused in patients with HF and reduced ejection fraction. 23,24 In a HFA consensus document, Rosano et al. 25 identified nine patient profiles which may inform treatment choices. These profiles include patients with atrial fibrillation, low blood pressure, tachycardia, chronic kidney disease, hyperkalaemia, congestion, or pre-discharge status. A strategy of rapid sequencing of evidence-based treatment was also proposed to optimize medical treatment. 26

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“…Nonetheless, limitations of the current study should be recognized 9 . First, the observational nature of this analysis precludes definitive determination of cause–effect relationships.…”

Section: Figurementioning

confidence: 90%

“…11,12 Nonetheless, limitations of the current study should be recognized. 9 First, the observational nature of this analysis precludes definitive determination of cause-effect relationships. Despite rigorous statistical methods, residual or unmeasured confounding may contribute to the results seen here.…”

mentioning

confidence: 99%

Sodium–glucose co‐transporter 2 inhibitors for heart failure: clinical trial efficacy and clinical practice effectiveness

Khan

Fonarow

Greene

2021

European J of Heart Fail

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This article refers to 'Use of sodium-glucose co-transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus: data from the Swedish Heart Failure Registry' by P.M. Becher et al., published in this issue on pages 1012-1022.Recent randomized controlled trials have established sodiumglucose co-transporter 2 (SGLT-2) inhibitors as a new cornerstone therapy for patients with heart failure (HF) with reduced ejection fraction (HFrEF). 1 These trials showed SGLT-2 inhibitors to significantly reduce cardiovascular mortality and HF hospitalization, with consistent efficacy regardless of diabetes status. 1 These benefits for traditional cardiovascular outcomes were combined with improvements in patient-reported quality of life, improvements in New York Heart Association functional class, and less progression of renal disease. 1 Moreover, benefits with respect to clinical events and quality of life were seen within days to weeks of initiation, suggesting that any delay in therapy exposes patients to substantial excess risk. 2,3 Combined with the other pillars of comprehensive disease-modifying quadruple therapy [angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA)], use of SGLT-2 inhibitors may reduce risk of mortality for patients with HFrEF by 73% over 2 years. 4 However, as we laud SGLT-2 inhibitors as a major therapeutic advance, history has taught us that strong efficacy and safety in clinical trials are unfortunately not enough to ensure robust real-world use of life-saving therapies for HFrEF. For example, in contemporary European and US clinical practice, among patients eligible for therapy, high proportions do not receive a renin-angiotensin system inhibitor, beta-blocker, or MRA, or receive therapies at sub-target doses. [5][6][7] Challenges with implementation may be particularly pronounced for newer therapies, where early adoption is generally slow and varied.

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Use of sodium–glucose co‐transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus: data from the Swedish Heart Failure Registry

Abstract: Use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in real-world heart failure (HF) is poorly characterised. In contemporary patients with HF and type 2 diabetes mellitus (T2DM) we assessed over time SGLT2i use, clinical characteristics and outcomes associated with SGLT2i use.

Cited by 40 publications

References 31 publications

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

June 2021 at a glance: focus on epidemiology, biomarkers and medical treatment

Sodium–glucose co‐transporter 2 inhibitors for heart failure: clinical trial efficacy and clinical practice effectiveness

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