Temporal trends and factors associated with SGLT2 inhibitor prescription in a nationwide French heart failure remote monitoring program

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended across the spectrum of heart failure (HF), yet data on their real-world uptake remain limited. We evaluated temporal trends and clinical determinants of SGLT2 inhibitor use in patients enrolled in a nationwide HF remote monitoring programme (RMP). METHODS: This analysis included 13,660 adults with chronic HF (median age 78 years, 43% women, 46% HFrEF) enrolled in a nationwide RMP between 2021 and 2024. Temporal patterns of SGLT2 inhibitor uptake were assessed across four predefined periods aligned with major trial and guideline publication. RESULTS: Overall, 64.4% of patients received an SGLT2 inhibitor at programme entry. Uptake increased markedly over time but followed distinct phenotype-specific patterns. In HFrEF, adoption rose sharply following the 2021 ESC HF Guidelines update and subsequently plateaued. In HFmrEF/HFpEF, uptake increased steeply after publication of EMPEROR-Preserved, then more gradually after DELIVER, reaching a plateau following the 2023 ESC HF guideline update. Study period (with progressively higher adjusted odd ratios [aOR] across periods 6.4-28.8), diabetes (aOR 1.39), home-visiting nurse assistance (aOR 1.52), and follow-up in university hospitals (aOR 2.12) were associated with higher SGLT2 inhibitor prescription, whereas HFmrEF (aOR 0.52), HFpEF (aOR 0.31), and chronic kidney disease (CKD; aOR 0.75) were associated with lower use. CONCLUSIONS: In this nationwide RMP, SGLT2 inhibitor prescription at programme entry increased rapidly following major trial and guideline publications, reaching high levels across HF phenotypes, although CKD remained associated with lower prescription, suggesting a residual opportunity for treatment optimization. TRIAL REGISTRATION: ClinicalTrials.gov #NCT07022379.