Current status and factors associated with SGLT2i and MRA utilization for hospitalized heart failure with mildly reduced or preserved ejection fraction : a survey from JROAD-DPC database
K Nakao, Y M Nakao, Y Sumita, K Kanaoka, K Takagi, S Yoneda, Y Asaumi, Y Kataoka, Y Miyamoto, T NoguchiAbstract
Background
Recent evidence have emphasized the role of sodium–glucose cotransporter 2 inhibitors (SGLT2is) and mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF). However, comprehensive nationwide data regarding real world utilization of these medications and factors associated with their use remain limited.
Purpose
To evaluate contemporary utilization of SGLT2is and MRAs among patients hospitalized with HFmrEF or HFpEF and to identify patient level and hospital level factors associated with their use.
Methods
We analyzed data from the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC) database provided by the Japanese Circulation Society. Patients hospitalized with HFmrEF or HFpEF in 2022 who were discharged alive were included. The proportions of patients treated with SGLT2is and MRAs during hospitalization or at discharge were assessed. Associations between patient level and hospital level factors and their utilization were examined. Multivariate mixed effects logistic regression models were constructed to identify factors associated with the likelihood of treatment, with hospital treated as a random intercept.
Results
A total of 62,812 patients with HFmrEF (n=20,421) or HFpEF (n=42,391) from 845 hospitals were analyzed. Overall, 31% were treated with SGLT2is and 52% with MRAs. Female (27% vs 36% in male), lower body mass index (BMI <18.5: 22% vs BMI ≥30: 46%), and advanced age (≥80 years: 28% vs <60 years: 40%) were associated with lower SGLT2is use. In contrast, male (50% vs 55% in female) and chronic kidney disease (41% vs 54% in those without CKD) were associated with lower MRA use. Cardiomyopathy was associated with increased use of both SGLT2is and MRAs. Compared with HFpEF, patients with HFmrEF were more likely to be treated with both medications. These findings remained consistent after multivariable adjustment. In the hospital level factors, a greater number of Japanese Circulation Society certified cardiology specialists per hospitals was independently associated with a higher likelihood of guideline directed medical therapy use (≥10 vs ≤2 specialists: OR 1.21 [1.13–1.30], P<0.001), although the magnitude of association was modest.
Conclusions
Distinct patient characteristics were associated with the use of SGLT2is and MRAs in HFmrEF and HFpEF. Patients with cardiomyopathy and those with HFmrEF were more likely to receive both therapies. Although cardiology specialist availability was associated with greater use, the clinical impact appeared limited. Strategies to reduce the evidence practice gap in HFmrEF and HFpEF management are warranted.