(124) Prescribing Trends of SGLT2 Inhibitors Among Patients with Heart Failure in the U.S., 2013-2020

Publication Number: 785

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits among patients with heart failure (HF) in pivotal clinical trials and are now a component of guideline-recommended medical treatment for HF – regardless of type 2 diabetes (T2DM) status. However, there is paucity of data examining SGLT2i prescribing among HF patients with and without T2DM, or among subpopulations of heart failure with reduced (HFrEF) or preserved ejection fraction (HFpEF).

Objectives: To evaluate the prescribing patterns of SGLT2i among adults with HF between 2013 and 2020, stratified by comorbid diabetes and HF subtype.

Methods: This was a serial, cross-sectional study using US MarketScan commercial claims data from 2013 to 2020. Two mutually exclusive cohorts of adults with HFrEF and HFpEF were identified. Cohort membership was restricted to patients with either HFrEF or HFpEF as evidenced by corresponding diagnosis codes. Patients without adequate continuous enrollment or evidence of both HF subtypes were excluded from analysis. Prevalence of SGLT2i was calculated for each calendar year and temporal trends were evaluated; analyses were stratified by T2DM status.

Results: Among 237,779 HFrEF patients (mean (SD): 54.3 years; 66.5% male), the prevalence of use of SGLT2i over the study period was 3.6%, increasing from 0.3% in 2013 to 9.4% in 2020. Similarly, among HFpEF patients (mean (SD): 55.8 years; 51.3% female), the prevalence of SGLT2i use was 3.3%, but increased from 0.5% in 2013 to 6.7% by 2020. However, this increase in the uptake of SGLT2i was primarily driven in the subgroup of patients with comorbid T2DM; for instance, over the study period, only 0.3% and 0.1% of the non-diabetic HFrEF and HFpEF patients had evidence of SGLT2i use, and its use remained relatively low even after the publication of landmark trials in 2018; for instance, by 2020, only 1.8% and 0.3% of non-diabetic HFrEF and HFpEF patients were using SGLT2i.

Conclusions: SGLT2i were rarely prescribed among HF patients without comorbid T2DM regardless of HF subtype. While the uptake of SGLT2i did increase modestly over the course of the study period – coinciding with the publication of pivotal clinical trial results – it was driven primarily by the subgroup of patients with T2DM. Future work identifying barriers associated the uptake of SGLT2i among non-diabetic heart failure patients is needed.