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. 2020 Aug 1;5(8):948-951.
doi: 10.1001/jamacardio.2020.0898.

Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure

Nikhil S Bassi  1 , Boback Ziaeian  1 , Clyde W Yancy  2   3 , Gregg C Fonarow  1   4   5
Affiliations

Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure

Nikhil S Bassi et al. JAMA Cardiol. .

Abstract

Importance: Sodium-glucose cotransporter 2 inhibitor (SGLT2-i) therapy provided incremental survival benefit to patients with heart failure and reduced ejection fraction (HFrEF) who received guideline-directed medical therapy regardless of type 2 diabetes status in a recent clinical trial. To date, estimation of the potential benefits that could be gained from optimal implementation of SGLT2-i therapy at the population level has not been quantified.

Objective: To quantify the projected gains for deaths prevented or postponed with comprehensive implementation of SGLT2-i therapy for patients with HFrEF in the United States.

Design, setting, and participants: This decision analytical model, performed from September 25 to October 20, 2019, used published sources to estimate the US population of patients with HFrEF eligible for SGLT2-i therapy and the numbers needed to treat to prevent or postpone overt death. Sensitivity analyses were performed to account for the range of potential benefits.

Main outcomes and measures: All-cause mortality.

Results: Of the 3.1 million patients with HFrEF in the United States, 2 132 800 (69%) were projected to be candidates for SGLT2-i therapy. Optimal implementation of SGLT2-i therapy was empirically estimated to prevent up to 34 125 deaths per year (range 21 840-49 140 deaths per year). A secondary analysis excluding patients on the basis of N-terminal-pro brain natriuretic peptide levels and other trial entry criteria would yield a potential benefit of 25 594 deaths per year prevented (range, 16 380-36 855 deaths per year prevented).

Conclusions and relevance: This study suggests that a substantial number of deaths in the United States could be prevented by optimal implementation of SGLT2-i therapy. These data support implementation of the current evidence into practice in a timely manner to achieve important public health benefits and to reduce the mortality burden of HFrEF.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ziaeian reported receiving grants from the American Heart Association and the National Institutes of Health/National Center for Advancing Translational Science. Dr Yancy reported that his spouse works for Abbott Inc. Dr Fonarow reported receiving personal fees from Abbott, Amgen, AstraZeneca, Bayer, CHF Solutions, Janssen, Medtronic, Merck, and Novartis and grants from the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Sodium-Glucose Cotransporter 2 Inhibitor (SGLT2-i) Therapy Eligibility Flow Diagram
Derivation of the population of patients with heart failure and reduced ejection fraction eligible for SGLT2-i therapy. GFR indicates glomerular filtration rate; HFrEF, heart failure with reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; and NYHA, New York Heart Association.
See this image and copyright information in PMC

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