Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study

Abstract

Aims: We aimed to determine the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and to identify clinical factors associated with their use in patients with heart failure (HF) in a real-life setting.

Methods: Real-world data on Empagliflozin and Dapagliflozin use in patients with HEART failure: The RED-HEART study is a multicentre, cross-sectional and observational study that included HF patients in the outpatient setting regardless of ejection fraction from 19 cardiology centres between August 2023 and December 2023.

Results: The study population consisted of 1923 patients with HF, predominantly men (61.2%), with a median age of 66 (range: 19-101) years. Overall, 925 patients (48.1%) were receiving SGLT2is. Among the study population, 22.1% had HF with preserved ejection fraction, 21.5% had HF with mildly reduced ejection fraction, 56.4% had HF with reduced ejection fraction and the use of SGLT2is was 42.0%, 47.9% and 50.6% in each group, respectively (P = 0.012). The use of SGLT2is was 76.6% in patients with HF and diabetes, 19.8% in patients with HF and chronic kidney disease and 26.8% in patients without diabetes and chronic kidney disease (P < 0.001). Higher education level [odds ratio (OR): 1.80; 95% confidence interval (CI): 1.06-3.05; P = 0.027], higher household income (OR: 3.46; 95% CI: 1.27-9.42; P = 0.015), New York Heart Association functional class IV (OR: 2.72; 95% CI: 1.16-6.35; P = 0.021), diabetes (OR: 9.42; 95% CI: 6.72-13.20; P < 0.001), the use of angiotensin receptor-neprilysin inhibitors (ARNis) (OR: 4.09; 95% CI: 2.39-7.01; P < 0.001), the use of mineralocorticoid receptor antagonists (MRAs) (OR: 2.02; 95% CI: 1.49-2.75; P < 0.001), the use of loop diuretics (OR: 1.62; 95% CI: 1.18-2.22; P = 0.003) and the use of thiazide diuretics (OR: 1.72; 95% CI: 1.30-2.29; P < 0.001) were independently associated with the use of SGLT2is. Conversely, atrial fibrillation (OR: 0.63; 95% CI: 0.45-0.88; P = 0.008), chronic kidney disease (OR: 0.53; 95% CI: 0.37-0.76; P = 0.001), the use of dihydropyridine calcium channel blockers (OR: 0.68; 95% CI: 0.48-0.98; P = 0.042) and the use of statins (OR: 0.67; 95% CI: 0.49-0.91; P = 0.010) were independently associated with the non-use of SGLT2is.

Conclusions: The RED-HEART study provided comprehensive real-world data about implementing SGLT2is in patients with HF. These results suggest that there is a need for organized action and close collaboration between healthcare providers to improve the implementation of SGLT2is, especially in patients with HF with preserved ejection fraction and chronic kidney disease.

Keywords: guideline; heart failure; sodium–glucose cotransporter 2 inhibitors.

Figure 1

The use of sodium–glucose cotransporter 2 inhibitors (SGLT2is) according to the heart failure (HF) types. HFmrEF, HF with mildly reduced ejection fraction; HFpEF, HF with preserved ejection fraction; HFrEF, HF with reduced ejection fraction.

Figure 2

The use of sodium–glucose cotransporter 2 inhibitors (SGLT2is) according to the presence or absence of diabetes mellitus (DM) and chronic kidney disease (CKD). HF, heart failure.

Figure 3

The use of heart failure (HF) medications comprising angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers or angiotensin receptor–neprilysin inhibitors, beta‐blockers, mineralocorticoid receptor antagonists and sodium–glucose cotransporter 2 inhibitors among the study population and different HF types. HFmrEF, HF with mildly reduced ejection fraction; HFpEF, HF with preserved ejection fraction; HFrEF, HF with reduced ejection fraction.

Figure 4

Independent predictors of the use or non‐use of sodium–glucose cotransporter 2 inhibitors (SGLT2is) among the study population, regardless of ejection fraction. ARNis, angiotensin receptor–neprilysin inhibitors; DHP CCBs, dihydropyridine calcium channel blockers; MRAs, mineralocorticoid receptor antagonists; NYHA, New York Heart Association.