Projected Clinical Benefits of Implementation of SGLT-2 Inhibitors Among Medicare Beneficiaries Hospitalized for Heart Failure.

dc.contributor.author

Vaduganathan, Muthiah

dc.contributor.author

Greene, Stephen J

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Zhang, Shuaiqi

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Solomon, Nicole

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Chiswell, Karen

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Devore, Adam D

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Butler, Javed

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Heidenreich, Paul A

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Huang, Joanna C

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Kittleson, Michelle M

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Joynt Maddox, Karen E

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Mcdermott, James J

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Owens, Anjali Tiku

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Peterson, Pamela N

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Solomon, Scott D

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Vardeny, Orly

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Yancy, Clyde W

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Fonarow, Gregg C

dc.date.accessioned

2024-06-06T15:19:37Z

dc.date.available

2024-06-06T15:19:37Z

dc.date.issued

2022-04

dc.description.abstract

Background

The sodium-glucose cotransporter-2 (SGLT-2) inhibitors form the latest pillar in the management of heart failure with reduced ejection fraction (HFrEF) and appear to be effective across a range of patient profiles. There is increasing interest in initiating SGLT-2 inhibitors during hospitalization, yet little is known about the putative benefits of this implementation strategy.

Methods

We evaluated Medicare beneficiaries with HFrEF (≤ 40%) hospitalized at 228 sites in the Get With The Guidelines-Heart Failure (GWTG-HF) registry in 2016 who had linked claims data for ≥ 1 year postdischarge. We identified those eligible for dapagliflozin under the latest U.S. Food and Drug Administration label (excluding estimated glomerular filtration rates < 25 mL/min per 1.73 m2, dialysis and type 1 diabetes). We evaluated 1-year outcomes overall and among key subgroups (age ≥ 75 years, gender, race, hospital region, kidney function, diabetes status, triple therapy). We then projected the potential benefits of implementation of dapagliflozin based on the risk reductions observed in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial.

Results

Among 7523 patients hospitalized for HFrEF, 6576 (87%) would be candidates for dapagliflozin (mean age 79 ± 8 years, 39% women, 11% Black). Among eligible candidates, discharge use of β-blockers, ACEi/ARB, MRA, ARNI, and triple therapy (ACEi/ARB/ARNI+β-blocker+MRA) was recorded in 88%, 64%, 29%, 3%, and 20%, respectively. Among treatment-eligible patients, the 1-year incidence (95% CI) of mortality was 37% (36-38%) and of HF readmission was 33% (32-34%), and each exceeded 25% across all key subgroups. Among 1333 beneficiaries eligible for dapagliflozin who were already on triple therapy, the 1-year incidence of mortality was 26% (24%-29%) and the 1-year readmission due to HF was 30% (27%-32%). Applying the relative risk reductions observed in DAPA-HF, absolute risk reductions with complete implementation of dapagliflozin among treatment-eligible Medicare beneficiaries are projected to be 5% (1%-9%) for mortality and 9% (5%-12%) for HF readmission by 1 year. The projected number of Medicare beneficiaries who would need to be treated for 1 year to prevent 1 death is 19 (11-114), and 12 (8-21) would need to be treated to prevent 1 readmission due to HF.

Conclusions

Medicare beneficiaries with HFrEF who are eligible for dapagliflozin after hospitalization due to HF, including those well-treated with other disease-modifying therapies, face high risks of mortality and HF readmission by 1 year. If the benefits of reductions in death and hospitalizations due to HF observed in clinical trials can be fully realized, the absolute benefits of implementation of SGLT-2 inhibitors among treatment-eligible candidates are anticipated to be substantial in this high-risk postdischarge setting.
dc.identifier

S1071-9164(21)00470-X

dc.identifier.issn

1071-9164

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1532-8414

dc.identifier.uri

https://hdl.handle.net/10161/31136

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

Journal of cardiac failure

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10.1016/j.cardfail.2021.11.010

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.subject

Humans

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Ventricular Dysfunction, Left

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Adrenergic beta-Antagonists

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Angiotensin-Converting Enzyme Inhibitors

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Stroke Volume

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Aftercare

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Hospitalization

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Patient Discharge

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Aged

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Aged, 80 and over

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Medicare

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United States

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Female

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Male

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Heart Failure

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Angiotensin Receptor Antagonists

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Sodium-Glucose Transporter 2 Inhibitors

dc.title

Projected Clinical Benefits of Implementation of SGLT-2 Inhibitors Among Medicare Beneficiaries Hospitalized for Heart Failure.

dc.type

Journal article

duke.contributor.orcid

Greene, Stephen J|0000-0001-6912-7374

duke.contributor.orcid

Solomon, Nicole|0000-0002-5643-9958

duke.contributor.orcid

Chiswell, Karen|0000-0002-0279-9093

duke.contributor.orcid

Devore, Adam D|0000-0002-4679-2221

pubs.begin-page

554

pubs.end-page

563

pubs.issue

4

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Staff

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Biostatistics & Bioinformatics

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Medicine

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Medicine, Cardiology

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Duke Clinical Research Institute

pubs.publication-status

Published

pubs.volume

28

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