UTILIZATION OF SGLT2 INHIBITORS IN OUTPATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION ACCORDING TO 2022 VIETNAM NATIONAL HEART ASSOCIATION GUIDELINE

Xuân Tiến Mai, Kim Trang Trần, Mạnh nhân Vũ

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Abstract

Background: Heart failure with reduced ejection fraction (HFrEF) is a public health issue. Patients with HFrEF have a poor prognosis, high hospitalization rate, reduced quality of life, and bear high treatment costs. To improve outcomes in heart failure, current national and international guidelines recommend to use Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors for patients with HFrEF. Objectives: (1) To determine the proportion of outpatients with chronic heart failure with reduced ejection fraction receiving SGLT2 inhibitors as recommended by the Vietnam National Heart Association’s 2022 guidelines. (2) To describe certain clinical, laboratory, and treatment characteristics of the population of HFrEF patients with and without SGLT2 inhibitor treatment. (3) To survey the use of SGLT2 inhibitors: types of drugs, dosages, side effects, and reasons for not prescribing SGLT2 inhibitors. Subjects: Outpatients with HFrEF were treated at the Cardiology Clinic and Heart Failure Clinic of University Medical Center Ho Chi Minh City, Campus 1, from January 2024 to June 2024. Study Design: Descriptive cross-sectional study. Results: The usage rate of SGLT2 inhibitors among patients with chronic HFrEF was 87.9%. Compared to the non-SGLT2 inhibitor group, the SGLT2 inhibitor group had lower systolic and diastolic blood pressures (p<0.001 and p=0.028), higher hemoglobin and eGFR levels (p<0.001), and lower creatinine and NT-proBNP levels (p<0.001). Among those using SGLT2 inhibitors, 25.9% were on Empagliflozin and 74.1% on Dapagliflozin, with 96.4% of patients reaching the target dose. Among patients not using SGLT2 inhibitors, 75.0% were due to contraindications, 6.8% due to side effects, and 18.2% due to patient refusal. Conclusion: The majority of outpatients with HFrEF were treated with SGLT2 inhibitors, with a high percentage reaching the target dose. There were notable differences in certain clinical and laboratory characteristics between the groups treated with and without SGLT2 inhibitors. Contraindications, undesirable side effects, and treatment costs remain main barriers to optimizing therapy

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References

Chioncel O, Lainscak M, Seferovic PM, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction. ESC-HF-LT. 2017;19(12):1574-1585. doi:10.1002/ejhf.813
2. Urbich M, Globe G, Pantiri K, Heisen M, Bennison C, Wirtz HS, Di Tanna GL. A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020). PharmacoEconomics. 2020;38(11):1219-1236. doi:10.1007/s40273-020-00952-0
3. Dhaliwal A, Toma M, Kochan A, Didi A. Identifying Barriers To SGLT2 Inhibitor Use In Eligible Patients With Heart Failure: A Real-world Experience From A Single Centre. Journal of Cardiac Failure. 2022;28(5, Supplement):S48-S49. doi:10.1016/j.cardfail.2022.03.128
4. Phan Đình Phong, Phạm Thị Mai Hương, Đặng Việt Phong, Nguyễn Ngọc Quang. Thực trạng sử dụng các nhóm thuốc nền tảng trong điều trị suy tim mạn tính có phân suất tống máu giảm tại khoa khám bệnh - bệnh viện Bạch Mai. Tạp chí Y học Việt Nam. 2024;535(1B):238-243. doi:10.51298/vmj.v535i1B.8431
5. Nguyễn Phan Hoàng Phúc, Nguyễn Thanh Huân. Nghiên cứu tình hình suy dinh dưỡng của bệnh nhân cao tuổi ngoại trú có suy tim phân suất tống máu giảm. Tạp chí Y học Việt Nam. 2024; 538(2) :60-64. doi:10.51298 /vmj. v538i2.9424
6. Wei W, Liu J, Chen S, et al. Sodium Glucose Cotransporter Type 2 Inhibitors Improve Cardiorenal Outcome of Patients With Coronary Artery Disease: A Meta-Analysis. Frontiers in endocrinology. 2022;13. doi:10.3389/ fendo. 2022.850836
7. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. NEJM. 2020; 383(15):1413-1424. doi:10.1056/NEJMoa2022190
8. Savarese G, Kishi T, Vardeny O, et al. Heart failure drug treatment—inertia, titration, and discontinuation: a multinational observational study (EVOLUTION HF). JACC: Heart Failure. 2023;11(1):1-14. doi:10.1016/j.jchf.2022.08.009