Low but Rising Use of SGLT2 Inhibitors in Ambulatory Heart Failure Care Highlights Gaps in Implementation.

A cohort study published in JAMA Cardiology evaluated the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for heart failure (HF) in 759,915 patients enrolled in the NCDR PINNACLE registry between July 2019 and June 2023 across 191 US ambulatory cardiovascular care sites.

Main findings

Overall use

Only 10.1% of patients with HF were prescribed an SGLT2i. Use increased from 4.6% in 2019Q3 to 16.2% in 2023Q2.

By ejection fraction

Among patients with EF data: 17.9% of HFrEF, and 8.9% of HFmrEF or HFpEF received SGLT2i therapy.

Temporal trend

Significant increase in use over time across all HF phenotypes (P for trend <.001).

Disparities

Older adults (median age 80 vs 63), women (OR 0.79), and patients with higher systolic BP (OR 0.78) were less likely to receive SGLT2i. Patients with type 2 diabetes had markedly higher use (OR 3.21).

Practice variability

Wide inter-site variation persisted even after adjustment (OR for 90th vs 10th percentile: 4.40), suggesting non-clinical factors influence prescribing.

Implications

Although SGLT2 inhibitors are now standard of care across the spectrum of HF—regardless of diabetic status—their adoption remains inconsistent. This study underscores the need for targeted interventions, including clinician education, decision support tools, and quality metrics, to ensure more equitable and widespread implementation.

Editorial note: This content was developed with the support of artificial intelligence technologies to optimize the writing and structuring of the information. All material was carefully reviewed, validated, and supplemented by human experts prior to publication, ensuring scientific accuracy and adherence to good editorial practices.

#HeartFailure #SGLT2i #Cardiology #RealWorldData #HealthcareDisparities