{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:06:04Z","timestamp":1790697964273,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004242","name":"Princess Nourah bint Abdulrahman University","doi-asserted-by":"publisher","award":["PNURSP2026R814"],"award-info":[{"award-number":["PNURSP2026R814"]}],"id":[{"id":"10.13039\/501100004242","id-type":"DOI","asserted-by":"publisher"}]},{"award":["PNURSP2026R814"],"award-info":[{"award-number":["PNURSP2026R814"]}],"id":[{"id":"https:\/\/ror.org\/05b0cyh02","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are foundational therapy for heart failure with reduced ejection fraction (HFrEF), irrespective of diabetes. We evaluated recorded SGLT2i adoption and diabetes-related differences among adults with an electronic health record (EHR)-defined HFrEF phenotype at a Jordanian public hospital. Methods: This retrospective Hakeem cohort included 1750 adults. The frozen HFrEF phenotype was internally validated in an independent non-overlapping sample, and SGLT2i ascertainment was verified by complete-cohort medication review. Comparable annual analyses covered 2022\u20132025, when medication-source completeness exceeded 90%. Secondary analyses examined first recorded use after a 180-day lookback, concurrent four-class guideline-directed medical therapy (GDMT) in 2025, measured-eGFR threshold cohorts, and prespecified Firth regression among patients with type 2 diabetes (T2DM). Additional sensitivity analyses included a stable four-year cohort, a time-to-first-record analysis with explicit censoring, expanded model diagnostics with a time-to-event sensitivity analysis, and a strict directly documented-coverage GDMT analysis. Results: Sixty-four patients had verified recorded SGLT2i use (3.66%; 95% CI 2.83\u20134.65). Use was 11.41% (64\/561) with T2DM and 0% (0\/1189; exact 95% CI 0\u20130.31) without diabetes. Annual prevalence increased from 0.15% in 2022 to 5.13% in 2025 (absolute increase 4.98 percentage points), while remaining 0% without diabetes. In the stable four-year cohort sensitivity analysis, prevalence similarly increased from 0.21% to 5.34%. In the verified 12-month fixed-horizon cohort, 27\/1268 patients (2.13%) had a first recorded use within one year; the 322-day median was conditional on the 50 patients who eventually had a first post-index record and was not interpreted as a cohort-wide waiting time. Only 24\/936 patients (2.56%) had all four foundational classes concurrently active in the primary 2025 analysis. The inverse nondialysis-CKD estimate was treated as exploratory because only four treated patients had nondialysis CKD. Conclusions: Recorded adoption improved but remained low and strongly concentrated among patients with T2DM. Multicenter linkage of prescribing, eligibility, dispensing, persistence, and reimbursement data is needed to identify implementation mechanisms.<\/jats:p>","DOI":"10.3390\/jcm15197569","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:14:37Z","timestamp":1790694877000},"page":"7569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recorded Adoption of SGLT2 Inhibitors from 2022 to 2025 Among Adults with an EHR-Defined HFrEF Phenotype at a Jordanian Public Hospital"],"prefix":"10.3390","volume":"15","author":[{"given":"Tala Bassam","family":"Al-Bawalsah","sequence":"first","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy,\r\n\t  Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-1011","authenticated-orcid":false,"given":"Anas","family":"Abed","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy,\r\n\t  Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0395-7491","authenticated-orcid":false,"given":"Alhareth","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy,\r\n\t  Al-Ahliyya Amman University, Amman 19328, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5020-6838","authenticated-orcid":false,"given":"Sireen Abdul Rahim","family":"Shilbayeh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice,\r\n\t  Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","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."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/j.jacc.2023.12.024","article-title":"2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure with Reduced Ejection Fraction","volume":"83","author":"Maddox","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"K\u00f8ber, L., Adamo, M., Ruwald, A.C., Tomasoni, D., Anderson, L.J., Andersson, C., Brugts, J.J., Chioncel, O., Donal, E., and Ferdinandy, P. (2026). 2026 ESC Guidelines for the management of heart failure. Eur. Heart J., ehag100.","DOI":"10.1093\/eurheartj\/ehag100"},{"key":"ref_6","doi-asserted-by":"crossref","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."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1001\/jama.2020.1906","article-title":"Effect of dapagliflozin on worsening heart failure and cardiovascular death in patients with heart failure with and without diabetes","volume":"323","author":"Petrie","year":"2020","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","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."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1161\/CIRCULATIONAHA.120.051824","article-title":"Effect of empagliflozin on cardiovascular and renal outcomes in patients with heart failure by baseline diabetes status","volume":"143","author":"Anker","year":"2021","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S0140-6736(20)31824-9","article-title":"SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: A meta-analysis of the EMPEROR-Reduced and DAPA-HF trials","volume":"396","author":"Zannad","year":"2020","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1161\/CIRCULATIONAHA.121.058910","article-title":"Initial decline in estimated glomerular filtration rate after initiation of dapagliflozin in patients with heart failure and reduced ejection fraction","volume":"146","author":"Adamson","year":"2022","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in patients with chronic kidney disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","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."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1001\/jamacardio.2023.1266","article-title":"Contemporary use of sodium-glucose cotransporter-2 inhibitor therapy among patients hospitalized for heart failure with reduced ejection fraction in the US","volume":"8","author":"Pierce","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s40119-026-00458-4","article-title":"Utilization patterns and barriers to sodium-glucose cotransporter-2 inhibitor prescription in patients with heart failure: Real-world evidence from Saudi Arabia","volume":"15","author":"Alfehaid","year":"2026","journal-title":"Cardiol. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Abu-Hantash, H., Khader, Y., Al-Saleh, A., Al-Makhamreh, H., Ibdah, R., Ababneh, M., Nammas, A., Rasheed, A., Toubasi, A., and Al-Qalalweh, S. (2025). Clinical characteristics, management approaches, and outcomes of patients with heart failure: The Jordan Heart Failure Registry. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1592002"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Merdas, Z.J.H., Abed, A., Abu Assab, M., Abu Dayyih, W., Bustami, M., Saudi, L.M., and Shilbayeh, S.A.R. (2026). Barriers to prescribing and insurance approval of SGLT2 inhibitors for heart failure: A mixed-methods study in Jordan. Front. Pharmacol., 17.","DOI":"10.3389\/fphar.2026.1803731"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Benchimol, E.I., Smeeth, L., Guttmann, A., Harron, K., Moher, D., Petersen, I., S\u00f8rensen, H.T., von Elm, E., Langan, S.M., and RECORD Working Committee (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med., 12.","DOI":"10.1371\/journal.pmed.1001885"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C-based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e18464","DOI":"10.7717\/peerj.18464","article-title":"The use of four-pillar regimen for heart failure management: Results from the Jordanian Heart Failure Registry (JoHFR)","volume":"12","author":"Izraiq","year":"2024","journal-title":"PeerJ"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Buonpane, A., Ciardetti, M., Trimarchi, G., Scalone, G., Coceani, M.A., Pastormerlo, L.E., Marchi, F., Paradossi, U., Berti, S., and Passino, C. (2026). SGLT2 Inhibitors After Myocardial Infarction: Evidence, Mechanisms and Gaps in Knowledge. J. Clin. Med., 15.","DOI":"10.3390\/jcm15062260"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jchf.2022.08.009","article-title":"Heart failure drug treatment-inertia, titration, and discontinuation: A multinational observational study (EVOLUTION HF)","volume":"11","author":"Savarese","year":"2023","journal-title":"JACC Heart Fail."},{"key":"ref_23","doi-asserted-by":"crossref","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."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jchf.2021.09.004","article-title":"A systematic review and network meta-analysis of pharmacological treatment of heart failure with reduced ejection fraction","volume":"10","author":"Tromp","year":"2022","journal-title":"JACC Heart Fail."},{"key":"ref_25","doi-asserted-by":"crossref","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","volume":"396","author":"Vaduganathan","year":"2020","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","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."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1001\/jamacardio.2021.0496","article-title":"Simultaneous or rapid sequence initiation of quadruple medical therapy for heart failure","volume":"6","author":"Greene","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/S0140-6736(22)02076-1","article-title":"Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF)","volume":"400","author":"Mebazaa","year":"2022","journal-title":"Lancet"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7569\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:29:53Z","timestamp":1790695793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7569"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":28,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197569"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197569","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}