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

Abstract

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%. An additional 2 102 606 (95% CI 1 870 394–2 341 301) to 2 557 224 (95% CI 2 274 804–2 847 528) total worsening HF events and cardiovascular deaths would be prevented/postponed 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.