(P119) SODIUM-GLUCOSE TRANSPORT PROTEIN 2 INHIBITOR ELIGIBILITY FOR PATIENTS HOSPITALIZED WITH ACUTE HEART FAILURE

Background: Sodium-glucose co-transporter 2 inhibitors (SLGT2i) have demonstrated consistent clinical benefits in chronic heart failure (HF) with reduced ejection fraction (HFrEF), leading to their inclusion as part of the new standard of care for HFrEF. Furthermore, emerging evidence supports the safety and efficacy of early initiation of SGLT2i in acute HF. We aimed to evaluate the real-world generalizability of published and ongoing SGLT2i randomized controlled trials (RCTs) to patients hospitalized for HFrEF.

METHODS AND RESULTS: We performed a retrospective cohort study of all consecutive patients admitted to a medical or cardiology unit at St. Paul’s Hospital in Vancouver, British Columbia from November 19, 2019 to September 30, 2021. We included adults admitted for HF, with documented ejection fraction ≤ 40% during admission or within the prior 12 months, and who were discharged from hospital alive, excluding patients receiving palliative care. The primary outcome was the proportion of patients hospitalized for HFrEF eligible for an SGLT2i based on aggregated key eligibility criteria from acute HF RCTs: eGFR ≥ 20 mL/min/1.73m2; not pregnant/breastfeeding; heart failure not due to reversible, restrictive, or congenital causes; and no contraindications to SGLT2i (known hypersensitivity, type 1 diabetes, history of diabetic ketoacidosis). The secondary outcome was the proportion of patients hospitalized for HFrEF eligible for an SGLT2 based on individual eligibility criteria of landmark chronic (DAPA-HF, EMPEROR-Reduced) and acute (EMPA-RESPONSE-AHF, SOLOIST-WHF, EMPULSE, DICTATE-AHF, DAPA ACT HF-TIMI 68) HF RCTs. Of the 725 HF admissions screened, 150 patients met the inclusion criteria. The main reasons for study exclusion were HF with preserved EF and no documented ejection fraction ≤ 40% within 12 months prior. The median age was 66 years, 23% were female, median ejection fraction was 25%, median NT-proBNP was 7786 pg/mL, and 31% of patients had type 2 diabetes. Of these, 135 (90%) met the primary eligibility criteria for SLGT2i initiation. The most common reason for ineligibility was low eGFR (8%); others included HF due to distinct pathophysiology (2%) and contraindications to SGLT2i (2%). Individual trial eligibility ranged from 23.3% (DICTATE-AHF) to 79.1% (EMPULSE). Reasons for ineligibility varied between studies and included blood pressure below eligibility, lack of type 2 diabetes history, eGFR below eligibility, and natriuretic peptides below eligibility.

Conclusion: Patients enrolled in landmark RCTs of SGLT2i in acute and chronic HF are broadly representative of real-world patients hospitalized for HFrEF. Further quality improvement initiatives should be explored to optimize SGLT2 initiation in HF management.