Potential Global Impact of Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure.

Abstract

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are effective across the spectrum of the left ventricular ejection fraction (LVEF) in heart failure (HF); however, population-wide medication use in eligible patients remains suboptimal. We evaluated the potential implications of optimal global implementation of SGLT-2 inhibitors in HF. A decision analytical study was performed using the global prevalence of HF from the Global Burden of Disease 2017 report. Exclusion criteria were applied using the NHANES to ascertain an SGLT-2 inhibitor-eligible population, which was mapped onto global LVEF distributions from the REPORT-HF registry. The number needed to treat for 3 years for the composite of worsening HF events and cardiovascular deaths was calculated from estimated event rates in the EMPEROR-Reduced, EMPEROR-Preserved, DAPA-HF, and DELIVER trials and projected onto the eligible population. An estimated 49,329,000 (95%CI, 43,882,000-54,929,000) HF patients would be eligible for SGLT-2 inhibitors across all LVEFs, including 25,651,000 (95%CI, 22,818,000-28,563,000) with LVEF of <40% and 23,678,000 (95%CI, 21,063,000-26,366,000) with LVEF >40%. Optimal implementation of SGLT-2 inhibitors would be projected to prevent/postpone 4,512,011 (95%CI, 4,013,686-5,024,232) to 5,986,943 (95%CI, 5,325,721-6,666,604) total worsening HF events and cardiovascular deaths over 3 years in patients with LVEF <40%. An additional 2,102,606 (95%CI, 1,870,394-2,341,301) to 2,557,224 (95%CI, 2,274,804-2,847,528) events would be prevented/postponed in patients with LVEF >40%. Among all eligible HF patients, irrespective of LVEF, 7,069,235 (95%CI, 6,288,490-7,871,760) to 8,089,549 (95%CI, 7,196,115-9,007,905) total worsening HF events and cardiovascular deaths would be prevented/postponed over this period. Optimal implementation of SGLT-2 inhibitors globally in HF is projected to prevent approximately 7-8 million worsening HF events and cardiovascular deaths over 3 years. This article is protected by copyright. All rights reserved.