Objective:

To evaluate the impact of socioeconomic factors on the initiation of SGLT2 inhibitors in patients diagnosed with heart failure.

Approach:

• Study Design: Retrospective analysis using German statutory health insurance claims data linked with municipal socioeconomic information.
• Cohort: Identified 90,841 patients with heart failure, excluding those with prior SGLT2 use, contraindications, mortality during follow-up, or missing data, resulting in 68,426 treatment-naive patients.
• Outcome Measurement: Primary outcome was the initiation of dapagliflozin or empagliflozin during 2023, analyzed using multilevel logistic regression.

Key Findings:

• Only 14.2% of participants initiated SGLT2 inhibitors in 2023.
• Newly coded heart failure patients had over twice the odds of initiating treatment.
• Demographic factors such as female sex, pension status, family insurance, and recent relocation were associated with lower initiation rates.
• Higher municipal income tax was linked to a 21% greater likelihood of treatment initiation.
• Type 2 diabetes, chronic kidney disease, obesity, chronic obstructive pulmonary disease, asthma, and receipt of other guideline-directed heart failure drugs were associated with treatment initiation.

Interpretation:

Limitations:

• Study based on administrative claims data, limiting causal inference.
• Lack of clinical variables that may affect prescribing decisions.
• Potential selection bias due to exclusion of patients with missing information.

Conclusion:

Sources:

• Clinical Research in Cardiology