Optimal Prescription of SGLT2 Inhibitors in Hospitalized HFrEF Patients Could Provide Substantial Benefit
The most recent analysis from TRANSLATE-HF suggests optimal prescription of dapagliflozin, based on the FDA label, could reduce the risk of mortality and readmission among patients hospitalized for HFrEF.
The latest installment in the TRANSLATE-HF program provides insight into the potential impact of in-hospital initiation on post-discharge mortality and readmission among Medicare beneficiaries with heart failure.
A series of analyses examining data from the Get With the Guidelines-Heart Failure (GWTG-HF) registry, the latest data from the TRANSLATE-HF program suggest that, despite being included in contemporary guidelines and demonstrating efficacy in multiple phase 3 clinical trials, early adoption of SGLT2 inhibitors remains low prior to hospitalization and within the immediate post-discharge, which investigators purport represents an addressable gap in care.
“Medicare beneficiaries eligible for dapagliflozin after HF hospitalization, including those well-treated with other therapies, face high risks of mortality and HF readmission,” said Muthiah Vaduganathan, MD, lead investigator and cardiologist at Brigham and Women’s Hospital,
An industry-education collaboration, TRANSLATE-HF was designed as a series to include 6 studies to identify knowledge gaps and treatment barriers related to SGLT2 inhibitor use in heart failure management. With previous TRANSLATE-HF analyses presented at AHA 2020 and ACC 2021, the program has outlined the
The most recent analysis from the program, which was presented at the
Investigators identified a cohort of 7767 patients hospitalized for HFrEF. Of these, 6218 would have been considered eligible for an SGLT2 inhibitor prescription. This cohort of eligible patients had a mean age of 79±8 years, 38% were women, 12% were Black. Investigators pointed out an assessment of prescription data from these patients indicated use of beta-blockers, ACE inhibitors or ARBs, MRA, ARNI, and triple therapy was recorded in 88%, 64%, 29%, 3%, and 20%, respectively.
Among patients considered eligible for dapagliflozin, the 10-year incidence of mortality was 37% (95% CI, 36-38) and the rate of heart failure readmission was 33% (95% CI, 32-34). Additionally, investigators pointed out the 1-year incidence of mortality and rate of heart failure readmission exceed 25% in all subgroups. In an analysis of patients already on triple therapy, the 1-year incidence of mortality was 26% (95% CI, 24-29) and the rate of readmission was 30% (95% CI, 27-32).
After application of relative risk reductions observed in the DAPA-HF trial, estimated absolute risk reductions with optimal implementation of dapagliflozin were projected to be 5% (95% CI, 1-9) for 1-year incidence of mortality and 9% (95% CI, 5-12) for rate of heart failure readmission. When assessing the projected number needed to treat (NNT) to prevent a single death at 1 year was 19 (11-114) and the NNT to prevent a single heart failure readmission was 12 (8-21).
Investigators cautioned clinicians to consider limitations within their analysis when interpreting results. These included being restricted to Medicare Fee-for-Service beneficiaries, being restricted to hospitalizations occurring within 2016, and reliance on the DAPA-HF effect sizes.
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