USE OF SODIUM-GLUCOSE COTRANSPORTER-2 INHIBITORS BY CARDIOLOGISTS SINCE THE RELEASE OF 2022 AHA/ACC/HFSA GUIDELINES FOR THE MANAGEMENT OF HEART FAILURE

Abstract

Therapeutic Area: Heart Failure Background: Several studies have shown that most patients who are eligible for an Sodium-glucose Cotransporter-2 inhibitor (SGLT2i) are not receiving them and the proportion of prescriptions from cardiologists was very low (<2%) as of December 2020. Moreover, two SGLT2is, empagliflozin and dapagliflozin, were studied for the management of heart failure (HF) and demonstrated significant reduction in the risk of CV death and HF hospitalization and were approved by the FDA for HF management regardless of diabetes. Since then, the new guidelines encouraging use in patients with HF, have been released, and have sparked increased cardiologist engagement with this drug class. Thus, we aimed to evaluate the use of these medications by cardiologists since the release of the HF guidelines. Methods: We used IQVIA's National Prescription Audit for our analysis, which estimates all retail prescription dispensing in the U.S. based on an audit of 93% of retail pharmacies. We conducted a descriptive analysis of monthly prescription volumes of HF-indicated SGLT2is, stratified by product and prescriber specialty, from March 2017 to February 2023. Results: From March 2017 to February 2023, about 75.3 million prescriptions of HF-indicated SGLT2is were dispensed in the U.S., of which about 2.2 million prescriptions (2.9%) were dispensed by cardiologists. Among cardiologists, monthly dispensed prescriptions of HF-indicated SGLT2is increased from 2,908 in March 2017 to 114,447 in February 2023, a ∼39-fold increase, while non-cardiologist prescribers demonstrated a 4.5-fold increase (from 411,456 to 1,851,937). Cardiologists’ contribution to overall use increased from 0.7% in March 2017 to 5.8% in February 2023. The average compounded monthly rate of increase in prescriptions was 6.9% and 4.4% in the 11 months prior to and after the publication of HF guidelines, respectively, with no notable change in the growth trend coinciding with publication. Conclusions: Use of HF-indicated SGLT2is by cardiologists has increased exponentially over the past six years due to rapidly evolving clinical trials data, expansion of FDA-approved CV indications, and changing insurance coverage. Although we did not observe any notable change in this growth trend coinciding with updated clinical guidelines, these results demonstrate increasing cardiologist engagement with this class of cardioprotective medications.