Observational studyClinical drug investigation2026
Determinants and Prognostic Impact of In-Hospital Sodium-Glucose Cotransporter-2 Inhibitor Initiation in Patients with Heart Failure.
Observational study in Clinical drug investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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12 authors.
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Abstract
BACKGROUND AND
objectivesInitiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients hospitalised for heart failure (HF) is crucial for improving long-term outcomes. However, in real-world practice, a considerable proportion of patients are discharged without initiation. This study aimed to evaluate the initiation rate of SGLT2i, identify clinical factors associated with non-initiation, and examine the impact on long-term prognosis in patients hospitalised for HF.
methodsThis single-centre, retrospective, observational analysis of a prospective registry included 781 consecutive patients who were hospitalised for HF between 2021 and 2024. The primary endpoint was the in-hospital initiation rate of SGLT2i. Secondary endpoints included clinical factors associated with non-initiation, assessed using multivariable logistic regression, and the incidence of the composite endpoint of all-cause mortality or HF rehospitalisation at 1 year according to SGLT2i prescription status at discharge, evaluated by log-rank test and Cox proportional hazards analysis.
resultsA total of 467 patients (median age 81 [74-87] years, 50.3% male) were included in the final analysis. The initiation rate of SGLT2i during hospitalisation was 37.3% (174/467), and treatment discontinuation after initiation occurred in 8.6% (15/174). Multivariable analysis revealed that older age, non-diabetes, impaired renal function, higher left ventricular ejection fraction, malnutrition, impaired mobility, and cognitive dysfunction were independently associated with non-initiation. Among 346 patients with available follow-up data, the incidence of the composite endpoint at 1 year was significantly higher in the non-initiation group than in the initiation group (37.5% vs 21.3%, log-rank p = 0.001). In multivariable Cox analysis, not prescribed SGLT2i at discharge remained independently associated with worse long-term outcomes (hazard ratio 1.70, 95% confidence interval 1.07-2.69, p = 0.02).
conclusionBoth conventional clinical factors (e.g., diabetes, left ventricular ejection fraction) and aging-related factors (e.g., nutritional status, mobility, cognitive function) were independently associated with non-initiation of SGLT2i in hospitalised patients with HF. Importantly, non-initiation at discharge was significantly associated with worse long-term outcomes, underscoring the need to promote active initiation of SGLT2i in this population.
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