Early initiation of sodium–glucose co-transporter-2 inhibitors in heart failure patients: a nationwide study

INTRODUCTION: While sodium-glucose co-transporter-2 inhibitors (SGLT-2i) have shown substantial benefit in heart failure (HF) across clinical trials and are now a cornerstone of HF guideline-directed medical therapy (GDMT), data on their use in Europe remains scarce. This study aimed to assess SGLT-2i initiation after a first HF hospitalization, identify its predictors, and evaluate between-hospital disparities. METHODS: Using the French National Healthcare Database (SNDS) between 2021 and 2023, SGLT-2i initiation was assessed in patients discharged from a first HF hospitalization, excluding patients with prior exposure to SGLT-2i. Multilevel logistic regression identified individual- and hospital-level predictors of SGLT-2i initiation and median odds ratio (MOR) estimated between-hospital variance in SGLT-2i initiation. RESULTS: Among 303 118 patients, 16.1% initiated SGLT-2is. Initiation rates were higher in patients ≤75 years (24.3% vs. 12.4%), males (19.7% vs. 12.4%), diabetics (18.9% vs. 14.8%), without chronic kidney disease (CKD) (17.4% vs. 11.4%), and with lower left ventricular ejection fraction (LVEF) (