ImportanceSodium-glucose cotransporter-2 inhibitors (SGLT2is) are the first therapy shown to improve clinical outcomes for patients with heart failure (HF) and a left ventricular ejection fraction (LVEF) greater than 40%. Nationwide adoption of SGLT2is in the US since publication of the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction (EMPEROR-Preserved) in August 2021 is unknown.ObjectiveTo examine trends and hospital-level variation in SGLT2i adoption.Design, Setting, and ParticipantsThis cohort study included patients with LVEF greater than 40% who were hospitalized for decompensated HF at 1 of 557 sites in the US between July 1, 2021, and September 30, 2023, from the Get With The Guidelines–Heart Failure registry.Main Outcomes and MeasuresPatient-level trends and site-level variation in prescription rates of SGLT2i at hospital discharge. Site-level variation was quantified using the median odds ratio, which describes the average odds that a patient being treated at one vs another randomly selected hospital would receive SGLT2i therapy at discharge.ResultsOf 158 849 patients (median [IQR] age, 76 [66-85] years; 89 816 females [56.5%]), 22 126 eligible patients (13.9%) with HF and an LVEF greater than 40% were prescribed an SGLT2i at hospital discharge. Quarterly prescription rates increased from 4.2% in July to September 2021 to 23.5% in July to September 2023 (P for trend < .001). SGLT2i prescription was more likely among patients with HF with mildly reduced LVEF (41%-49%) than in those with preserved LVEF (≥50%; 5127 of 27 712 patients [18.5%] vs 16 999 of 131 137 patients [13.0%]; absolute standardized difference, 16.7%). After adjustment for patient characteristics, there was a high variance between hospitals in the rate of SGLT2i prescription (median odds ratio, 2.12; 95% CI, 2.02-2.25). Among 518 hospitals with 10 or more eligible discharges, 11 hospitals (2.1%) discharged 50% or more of their patients with an SGLT2i prescription, while 232 (44.8%) discharged fewer than 10% of eligible patients with an SGLT2i prescription.Conclusion and RelevanceFor patients with HF and an LVEF greater than 40%, discharge prescription of SGLT2is increased from 4.2% to 23.5% during the first 2 years after the EMPEROR-Preserved trial demonstrating treatment benefits; however, these rates varied across US hospitals.

中文翻译：

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在射血分数轻度降低或保留的心力衰竭住院患者中早期采用钠-葡萄糖协同转运蛋白 2 抑制剂


重要性钠-葡萄糖协同转运蛋白 2 抑制剂 （SGLT2is） 是第一个被证明可以改善左心室射血分数 （LVEF） 大于 40% 的心力衰竭 （HF） 患者临床结局的疗法。自 2021 年 8 月发表射血分数保留的慢性心力衰竭 （EMPEROR-Preservation） 患者的恩格列净结局试验以来，SGLT2is 在美国的全国采用情况尚不清楚。目的检查 SGLT2i 采用的趋势和医院层面的差异。设计、设置和参与者这项队列研究包括 2021 年 7 月 1 日至 2023 年 9 月 30 日期间在美国 557 个地点中的 1 个地点因失代偿性 HF 住院的 LVEF 大于 40% 的患者，来自 Get With The Guidelines-心力衰竭登记处。主要结局和措施出院时 SGLT2i 处方率的患者水平趋势和现场水平变化。使用中位比值比量化站点水平的变异，该比值比描述了在一家随机选择的医院接受治疗的患者在出院时接受 SGLT2i 治疗的平均几率。结果在 158 849 例患者 （中位 [IQR] 年龄，76 [66-85] 岁;89 816 例女性 [56.5%]）中，22 126 例符合条件的 HF 患者 （13.9%） 和 LVEF 大于 40% 在出院时接受了 SGLT2i。季度处方率从 2021 年 7 月至 9 月的 4.2% 增加到 2023 年 7 月至 9 月的 23.5%（P 代表趋势 < .001）。SLLT2i 处方在 LVEF 轻度降低的 HF 患者 （41%-49%） 中比在 LVEF 保留患者中更可能 （≥50%;27 712 例患者中有 5127 例 [18.5%] vs 131 137 例患者中有 16 999 例 [13.0%];绝对标准化差异，16.7%）。 在调整患者特征后，医院间 SGLT2i 处方率存在很大差异 （中位比值比，2.12;95% CI，2.02-2.25）。在 518 家有 10 例或更多合格出院的医院中，11 家医院 （2.1%） 出院了 50% 或更多的 SGLT2i 处方患者，而 232 家 （44.8%） 出院的合格患者不到 10% 持有 SGLT2i 处方。结论和相关性对于 LVEF 大于 40% 的 HF 患者，在 EMPEROR-Preserved 试验证明治疗益处后的前 2 年，SGLT2 的出院处方从 4.2% 增加到 23.5%;然而，这些比率因美国医院而异。