Potential global impact of sodium–glucose cotransporter‐2 inhibitors in heart failure

摘要

Aims Sodium‐glucose cotransporter‐2 (SGLT‐2) inhibitors are effective across the spectrum of 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. Methods and results 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 DAPA‐HF, EMPEROR‐Reduced, EMPEROR‐Preserved, and DELIVER trials and projected onto the eligible population. An estimated 49?329?000 (95 confidence interval 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 ≤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. 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. Conclusions Optimal implementation of SGLT‐2 inhibitors globally in HF is projected to prevent/postpone approximately 7–8 million worsening HF events and cardiovascular deaths over 3?years.