1. In this decision analysis modeling study of 4.8 million US adults with heart failure, optimal performance of sodium-glucose cotransporter-2 (SGLT-2) inhibitors over 3 years resulted in 630,000 It was presumed that it could prevent or postpone worsening heart failure events. Across the left ventricular ejection fraction (LVEF) spectrum, approximately 230,000 to 280,000 preventable events were seen in patients with LVEF >40%.
2. An estimated 468,904 to 499,110 heart failure hospitalizations could be prevented across the LVEF spectrum, of which 172,870 to 231,018 could be prevented in individuals with >40% LVEF.
Evidence Rating Level: 2 (good)
Research overview: THE EMPEROR-Preserved (Empagliflozin Outcomes Trial in Patients with Chronic Heart Failure with Ejection Fraction Preserved) and DELIVER (Assessment of Dapagliflozin to Improve the Lives of Patients with Ejection Fraction-Preserved Heart Failure) It means a lot and is expanding. Use of sodium-glucose cotransport-2 (SGLT-2) inhibitors in heart failure (HF) patients. The objectives of this study are the EMPEROR-Reduced, EMPEROR-Preserved, DAPA-HF, and DELIVER trials. A secondary objective was to evaluate the benefit of SGLT-2 inhibitor therapy in patients with HF and LVEF >40%. The primary outcome was unplanned HF hospitalization, urgent HF visit requiring intravenous therapy, or worsening HF event, including cardiovascular death. A total of 4,794,524 adults with heart failure were eligible for his SGLT-2 inhibitor, of whom 2,619,248 were newly estimated to have her LVEF >40%. Based on estimates from the EMPEROR-Reduced, EMPEROR-Preserved, DAPA-HF, and DELIVER trials, 3 years of SGLT-2 inhibitor therapy prevented 624,247 worsening HF events across the LVEF range. 282,879 events were considered preventable, of which 232,589 were predicted in individuals with LVEF >40%. In addition, an estimated 468,904 to 499,110 total hospitalizations could be prevented by him across the LVEF spectrum, of which 172,870 to 231,018 were prevented in individuals with his LVEF >40%. A major strength of this study is its rather large sample size. A limitation, however, was that the predicted estimates did not consider adherence patterns, medication costs, and potential perceived or true side effects leading to medication discontinuation during SGLT-2 inhibitor therapy for heart failure.
Click to read the JAMA Cardiology study
detail [retrospective cohort]: This study quantified the estimated US population-level impact of reducing HF event exacerbation with SGLT-2 inhibitor therapy in individuals with LVEF >40%. A total of 4 794 524 (95% CI, 3 997 363-5 591 684) adults with heart failure (57% male, mean age 66 years) expected to receive SGLT-2 inhibitors, of whom 2 619 248 (95% CI) CI, 2 183, 759-3 054 737) were newly presumed eligible with an LVEF >40%. We used the National Health and Nutrition Examination Survey (NHANES) to estimate the weighted prevalence of heart failure patients in the United States. The figures required to process estimates over 3 years were obtained for outcome measures from the following trials: EMPEROR-Reduced, EMPEROR-Preserved, DAPA-HF, and DELIVER. Based on estimates from these studies, SGLT-2 reduced HF events from 624,247 (95% CI, 520 457-728,037) to 627,124 (95% CI, 522 855-731 392) across the LVEF spectrum. It is predicted that deterioration can be prevented. 232 589 (95% CI, 193 918-271 260) to 282 879 (95% CI, 235 846-329 912) events were considered preventable in individuals with LVEF >40%. In addition, an estimated 468,904 (95% CI, 390,942-546,867) to 499,110 (95% CI, 416,125-582,094) total hospitalizations could be prevented across the LVEF spectrum, of which 172,870 (95% CI, 144 128-201 613) from 231 018 (95% CI, 192 608-269 428) are preventable in individuals with LVEF >40%. Numbers needed to treat (NNT) over 3 years for all efficacy endpoints were similar across the LVEF spectrum, ranging from 9 to 13 for the composite endpoints of total HF hospitalizations and CV deaths, and total HF hospitalizations. ranged from 10 to 16.
Image: PD
©2022 2 Minute Medicine Co., Ltd.. all rights reserved. No work may be reproduced without the express written consent of 2 Minute Medicine Co., Ltd.. License inquiries hereNone of the articles should be construed as medical advice, nor should they be construed as such by the authors or 2 Minute Medicine, Inc.
