{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T01:35:14Z","timestamp":1794360914949,"version":"4.9.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"Importance<\/jats:title>Clinical guidelines for patients with heart failure with reduced ejection fraction (HFrEF) strongly recommend treatment with a sodium-glucose cotransporter-2 inhibitor (SGLT2i) to reduce cardiovascular mortality or HF hospitalization. Nationwide adoption of SGLT2i for HFrEF in the US is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize patterns of SGLT2i use among eligible US patients hospitalized for HFrEF.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study analyzed 49\u202f399 patients hospitalized for HFrEF across 489 sites in the Get With The Guidelines\u2013Heart Failure (GWTG-HF) registry between July 1, 2021, and June 30, 2022. Patients with an estimated glomerular filtration rate less than 20 mL\/min\/1.73 m2<\/jats:sup>, type 1 diabetes, and previous intolerance to SGLT2i were excluded.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Patient-level and hospital-level prescription of SGLT2i at hospital discharge.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 49\u202f399 included patients, 16\u202f548 (33.5%) were female, and the median (IQR) age was 67 (56-78) years. Overall, 9988 patients (20.2%) were prescribed an SGLT2i. SGLT2i prescription was less likely among patients with chronic kidney disease (CKD; 4550 of 24\u202f437 [18.6%] vs 5438 of 24\u202f962 [21.8%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) but more likely among patients with type 2 diabetes (T2D; 5721 of 21\u202f830 [26.2%] vs 4262 of 27\u202f545 [15.5%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and those with both T2D and CKD (2905 of 12\u202f236 [23.7%] vs 7078 vs 37\u202f139 [19.1%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Patients prescribed SGLT2i therapy were more likely to be prescribed background triple therapy with an angiotensin-converting enzyme inhibitor\/angiotensin receptor blocker\/angiotensin receptor\u2013neprilysin inhibitor, \u03b2-blocker, and mineralocorticoid receptor antagonist (4624 of 9988 [46.3%] vs 10\u202f880 of 39\u202f411 [27.6%]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), and 4624 of 49\u202f399 total study patients (9.4%) were discharged with prescriptions for quadruple medical therapy including SGLT2i. Among 461 hospitals with 10 or more eligible discharges, 19 hospitals (4.1%) discharged 50% or more of patients with prescriptions for SGLT2i, whereas 344 hospitals (74.6%) discharged less than 25% of patients with prescriptions for SGLT2i (including 29 [6.3%] that discharged zero patients with SGLT2i prescriptions). There was high between-hospital variance in the rate of SGLT2i prescription in unadjusted models (median odds ratio, 2.53; 95% CI, 2.36-2.74) and after adjustment for patient and hospital characteristics (median odds ratio, 2.51; 95% CI, 2.34-2.71).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this study, prescription of SGLT2i at hospital discharge among eligible patients with HFrEF was low, including among patients with comorbid CKD and T2D who have multiple indications for therapy, with substantial variation among US hospitals. Further efforts are needed to overcome implementation barriers and improve use of SGLT2i among patients with HFrEF.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2023.1266","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T09:30:41Z","timestamp":1684747841000},"page":"652","source":"Crossref","is-referenced-by-count":124,"title":["Contemporary Use of Sodium-Glucose Cotransporter-2 Inhibitor Therapy Among Patients Hospitalized for Heart Failure With Reduced Ejection Fraction in the US"],"prefix":"10.1001","volume":"8","author":[{"given":"Jacob B.","family":"Pierce","sequence":"first","affiliation":[{"name":"Department of Medicine, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles"},{"name":"Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uchechukwu","family":"Ikeaba","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Chiswell","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Mississippi Medical Center, Jackson"},{"name":"Baylor Scott and White Research Institute, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam D.","family":"DeVore","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna C.","family":"Huang","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle M.","family":"Kittleson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen E.","family":"Joynt Maddox","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthik K.","family":"Linganathan","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"McDermott","sequence":"additional","affiliation":[{"name":"AstraZeneca, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjali Tiku","family":"Owens","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela N.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Denver Health Medical Center, Denver, Colorado"},{"name":"Department of Medicine, University of Colorado Anschutz Medical Center. Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orly","family":"Vardeny","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clyde W.","family":"Yancy","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Deputy Editor, JAMA Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Greene","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Division of Cardiology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"17","key":"hoi230023r1","doi-asserted-by":"publisher","first-page":"e263","DOI":"10.1016\/j.jacc.2021.12.012","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"79","author":"Heidenreich","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"36","key":"hoi230023r2","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"7","key":"hoi230023r3","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1001\/jamacardio.2020.0640","article-title":"Assessment of limitations to optimization of guideline-directed medical therapy in heart failure from the GUIDE-IT trial: a secondary analysis of a randomized clinical trial.","volume":"5","author":"Fiuzat","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"22","key":"hoi230023r4","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1001\/jama.2021.20739","article-title":"Contextualizing risk among patients with heart failure.","volume":"326","author":"Greene","year":"2021","journal-title":"JAMA"},{"issue":"5","key":"hoi230023r5","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1001\/jamacardio.2020.7585","article-title":"Time to clinical benefit of dapagliflozin and significance of prior heart failure hospitalization in patients with heart failure with reduced ejection fraction.","volume":"6","author":"Berg","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"10244","key":"hoi230023r6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S0140-6736(20)30748-0","article-title":"Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials.","volume":"396","author":"Vaduganathan","year":"2020","journal-title":"Lancet"},{"issue":"8","key":"hoi230023r7","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1001\/jamacardio.2020.0898","article-title":"Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure.","volume":"5","author":"Bassi","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"19","key":"hoi230023r8","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1016\/j.jacc.2019.02.015","article-title":"Titration of medical therapy for heart failure with reduced ejection fraction.","volume":"73","author":"Greene","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"hoi230023r9","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jacc.2018.04.070","article-title":"Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry.","volume":"72","author":"Greene","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"hoi230023r10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.122.010176","article-title":"Adoption of sacubitril\/valsartan among patients with heart failure with mildly reduced or preserved ejection fraction: the Get With The Guidelines-Heart Failure Registry.","volume":"16","author":"Pierce","year":"2023","journal-title":"Circ Heart Fail"},{"issue":"4","key":"hoi230023r11","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.jchf.2016.12.018","article-title":"Early adoption of sacubitril\/valsartan for patients with heart failure with reduced ejection fraction: insights from Get With the Guidelines\u2013Heart Failure (GWTG-HF).","volume":"5","author":"Luo","year":"2017","journal-title":"JACC Heart Fail"},{"issue":"12","key":"hoi230023r12","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1001\/jamacardio.2021.3651","article-title":"Potential implications of expanded US Food and Drug Administration labeling for sacubitril\/valsartan in the US.","volume":"6","author":"Vaduganathan","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"5S","key":"hoi230023r13","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/j.kint.2022.06.008","article-title":"KDIGO 2022 clinical practice guideline for diabetes management in chronic kidney disease.","volume":"102","author":"Rossing","year":"2022","journal-title":"Kidney Int"},{"key":"hoi230023r14","doi-asserted-by":"publisher","first-page":"S140","DOI":"10.2337\/dc23-S009","article-title":"9. Pharmacologic approaches to glycemic treatment: Standards of Care in diabetes\u20142023.","volume":"46","author":"ElSayed","year":"2023","journal-title":"Diabetes Care"},{"issue":"4","key":"hoi230023r15","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1097\/01.hpc.0000243588.00012.79","article-title":"Overview of the American Heart Association \u201cGet With The Guidelines\u201d programs: coronary heart disease, stroke, and heart failure.","volume":"5","author":"Hong","year":"2006","journal-title":"Crit Pathw Cardiol"},{"issue":"5","key":"hoi230023r16","doi-asserted-by":"publisher","first-page":"S46","DOI":"10.1016\/j.ahj.2004.09.015","article-title":"The American Heart Association Get With The Guidelines program.","volume":"148","author":"Smaha","year":"2004","journal-title":"Am Heart J"},{"issue":"36","key":"hoi230023r17","doi-asserted-by":"publisher","first-page":"3402","DOI":"10.1093\/eurheartj\/ehaa496","article-title":"Effect of dapagliflozin according to baseline systolic blood pressure in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF).","volume":"41","author":"Serenelli","year":"2020","journal-title":"Eur Heart J"},{"issue":"13","key":"hoi230023r18","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1016\/j.jacc.2021.07.049","article-title":"Empagliflozin improves cardiovascular and renal outcomes in heart failure irrespective of systolic blood pressure.","volume":"78","author":"B\u00f6hm","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"7","key":"hoi230023r19","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/j.cardfail.2022.02.011","article-title":"Medical therapy during hospitalization for heart failure with reduced ejection fraction: the VICTORIA registry.","volume":"28","author":"Greene","year":"2022","journal-title":"J Card Fail"},{"key":"hoi230023r20","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.ahj.2021.11.011","article-title":"Is the Affordable Care Act Medicaid expansion associated with receipt of heart failure guideline-directed medical therapy by race and ethnicity?","volume":"244","author":"Breathett","year":"2022","journal-title":"Am Heart J"},{"issue":"6","key":"hoi230023r21","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1161\/CIRCHEARTFAILURE.113.000163","article-title":"Practice-level variation in use of recommended medications among outpatients with heart failure: insights from the NCDR PINNACLE program.","volume":"6","author":"Peterson","year":"2013","journal-title":"Circ Heart Fail"},{"issue":"12","key":"hoi230023r22","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002268","article-title":"Temporal trends and hospital variation in mineralocorticoid receptor antagonist use in veterans discharged with heart failure.","volume":"4","author":"Dev","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"hoi230023r23","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ahj.2020.03.017","article-title":"Barriers to prescribing glucose-lowering therapies with cardiometabolic benefits.","volume":"224","author":"Gao","year":"2020","journal-title":"Am Heart J"},{"issue":"7","key":"hoi230023r24","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1001\/jamacardio.2021.0496","article-title":"Simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure\u2014optimizing therapy with the need for speed.","volume":"6","author":"Greene","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"20","key":"hoi230023r25","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.1016\/j.jacc.2021.08.064","article-title":"In-hospital initiation of sodium-glucose cotransporter-2 inhibitors for heart failure with reduced ejection fraction.","volume":"78","author":"Rao","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"hoi230023r26","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1161\/CIRCULATIONAHA.120.051783","article-title":"Effect of empagliflozin on the clinical stability of patients with heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial.","volume":"143","author":"Packer","year":"2021","journal-title":"Circulation"},{"issue":"4","key":"hoi230023r27","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1161\/CIRCULATIONAHA.122.059725","article-title":"Effects of empagliflozin on symptoms, physical limitations, and quality of life in patients hospitalized for acute heart failure: results from the EMPULSE trial.","volume":"146","author":"Kosiborod","year":"2022","journal-title":"Circulation"},{"issue":"24","key":"hoi230023r28","doi-asserted-by":"publisher","first-page":"2542","DOI":"10.1001\/jama.2018.19232","article-title":"Association of the hospital readmissions reduction program with mortality among Medicare beneficiaries hospitalized for heart failure, acute myocardial infarction, and pneumonia.","volume":"320","author":"Wadhera","year":"2018","journal-title":"JAMA"},{"issue":"4","key":"hoi230023r29","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1161\/CIRCOUTCOMES.108.822692","article-title":"Representativeness of a national heart failure quality-of-care registry: comparison of OPTIMIZE-HF and non-OPTIMIZE-HF Medicare patients.","volume":"2","author":"Curtis","year":"2009","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"1","key":"hoi230023r30","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1161\/CIRCOUTCOMES.110.959122","article-title":"Get With The Guidelines program participation, process of care, and outcome for Medicare patients hospitalized with heart failure.","volume":"5","author":"Heidenreich","year":"2012","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"21","key":"hoi230023r31","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction.","volume":"381","author":"McMurray","year":"2019","journal-title":"N Engl J Med"},{"issue":"15","key":"hoi230023r32","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure.","volume":"383","author":"Packer","year":"2020","journal-title":"N Engl J Med"},{"issue":"3","key":"hoi230023r33","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1038\/s41591-021-01659-1","article-title":"The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial.","volume":"28","author":"Voors","year":"2022","journal-title":"Nat Med"}],"container-title":["JAMA Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/articlepdf\/2805332\/jamacardiology_pierce_2023_oi_230023_1688580085.5087.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T15:05:15Z","timestamp":1689174315000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamacardiology\/fullarticle\/2805332"}},"subtitle":["The Get With The Guidelines\u2013Heart Failure Registry"],"short-title":[],"issued":{"date-parts":[[2023,7,1]]},"references-count":33,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamacardio.2023.1266","relation":{},"ISSN":["2380-6583"],"issn-type":[{"value":"2380-6583","type":"print"}],"subject":[],"published":{"date-parts":[[2023,7,1]]}}}