TY - JOUR
T1 - Use of Sodium-Glucose Cotransporter-2 Inhibitors and Angiotensin ReceptorNeprilysin Inhibitors in Patients With Atrial Fibrillation and Heart Failure From 2021 to 2022
T2 - An Analysis of Real-World Data
AU - Alonso, Alvaro
AU - Morris, Alanna A.
AU - Naimi, Ashley I.
AU - Alam, Aniqa B.
AU - Li, Linzi
AU - Subramanya, Vinita
AU - Chen, Lin Yee
AU - Lutsey, Pamela L.
N1 - Publisher Copyright:
© 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2024/3/19
Y1 - 2024/3/19
N2 - BACKGROUND: Contemporary use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF) has not been described. METHODS AND RESULTS: We analyzed the MarketScan databases for the period January 1, 2021 to July 30, 2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower use, including demographics and comorbidities. The study population included 60 927 patients (mean age, 75 years; 43% women) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), whereas the corresponding figure was 6% for SGLT2i (13% in HFrEF, 5% in HFpEF). Use of both medications increased over the study period: ARNi from 9% to 12% (22%–29% in HFrEF, 6%–8% in HFpEF), and SGLT2i from 3% to 9% (6%–16% in HFrEF, 2%–7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower use of these 2 medication types overall and by HF type. CONCLUSIONS: Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among women and older individuals, though use is increasing. These results underscore the need for understanding reasons for these disparities and developing interventions to improve adoption of evidence-based therapies among patients with comorbid AF and HF.
AB - BACKGROUND: Contemporary use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor-neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF) has not been described. METHODS AND RESULTS: We analyzed the MarketScan databases for the period January 1, 2021 to July 30, 2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower use, including demographics and comorbidities. The study population included 60 927 patients (mean age, 75 years; 43% women) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), whereas the corresponding figure was 6% for SGLT2i (13% in HFrEF, 5% in HFpEF). Use of both medications increased over the study period: ARNi from 9% to 12% (22%–29% in HFrEF, 6%–8% in HFpEF), and SGLT2i from 3% to 9% (6%–16% in HFrEF, 2%–7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower use of these 2 medication types overall and by HF type. CONCLUSIONS: Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among women and older individuals, though use is increasing. These results underscore the need for understanding reasons for these disparities and developing interventions to improve adoption of evidence-based therapies among patients with comorbid AF and HF.
KW - angiotensin receptor-neprilysin inhibitors
KW - atrial fibrillation
KW - heart failure
KW - sodium-glucose cotransporter-2 inhibitors
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U2 - 10.1161/JAHA.123.032783
DO - 10.1161/JAHA.123.032783
M3 - Article
C2 - 38456406
AN - SCOPUS:85188479437
SN - 2047-9980
VL - 13
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 6
M1 - e032783
ER -