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Brief Report
May 6, 2020

Association of Optimal Implementation of Sodium-Glucose Cotransporter 2 Inhibitor Therapy With Outcome for Patients With Heart Failure

Author Affiliations
  • 1Division of Cardiology, University of California, Los Angeles (UCLA)
  • 2Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3Deputy Editor, JAMA Cardiology
  • 4Ahmanson–UCLA Cardiomyopathy Center, Ronald Reagan–UCLA Medical Center, Los Angeles, California
  • 5Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
JAMA Cardiol. Published online May 6, 2020. doi:10.1001/jamacardio.2020.0898
Key Points

Question  What would the reduction be in all-cause mortality for the US population if all eligible patients with heart failure with reduced ejection fraction were prescribed sodium-glucose cotransporter 2 inhibitor therapy?

Findings  This decision analytical model found that optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy for patients with heart failure with reduced ejection fraction would be estimated to result in as many as 34 125 lives saved per year (range, 21 840-49 140 lives saved per year).

Meaning  The timely addition of sodium-glucose cotransporter 2 inhibitor therapy to standard guideline-directed medical therapy, even if not fully deployed, has the potential to substantially reduce all-cause mortality among patients with heart failure in the United States.


Importance  Sodium-glucose cotransporter 2 inhibitor (SGLT2-i) therapy provided incremental survival benefit to patients with heart failure and reduced ejection fraction (HFrEF) who received guideline-directed medical therapy regardless of type 2 diabetes status in a recent clinical trial. To date, estimation of the potential benefits that could be gained from optimal implementation of SGLT2-i therapy at the population level has not been quantified.

Objective  To quantify the projected gains for deaths prevented or postponed with comprehensive implementation of SGLT2-i therapy for patients with HFrEF in the United States.

Design, Setting, and Participants  This decision analytical model, performed from September 25 to October 20, 2019, used published sources to estimate the US population of patients with HFrEF eligible for SGLT2-i therapy and the numbers needed to treat to prevent or postpone overt death. Sensitivity analyses were performed to account for the range of potential benefits.

Main Outcomes and Measures  All-cause mortality.

Results  Of the 3.1 million patients with HFrEF in the United States, 2 132 800 (69%) were projected to be candidates for SGLT2-i therapy. Optimal implementation of SGLT2-i therapy was empirically estimated to prevent up to 34 125 deaths per year (range 21 840-49 140 deaths per year). A secondary analysis excluding patients on the basis of N-terminal–pro brain natriuretic peptide levels and other trial entry criteria would yield a potential benefit of 25 594 deaths per year prevented (range, 16 380-36 855 deaths per year prevented).

Conclusions and Relevance  This study suggests that a substantial number of deaths in the United States could be prevented by optimal implementation of SGLT2-i therapy. These data support implementation of the current evidence into practice in a timely manner to achieve important public health benefits and to reduce the mortality burden of HFrEF.