Objective:
To evaluate the impact of socioeconomic factors on the initiation of SGLT2 inhibitors in patients diagnosed with heart failure.
Approach:
- Study Design: Retrospective analysis using German statutory health insurance claims data linked with municipal socioeconomic information.
- Cohort: Identified 90,841 patients with heart failure, excluding those with prior SGLT2 use, contraindications, mortality during follow-up, or missing data, resulting in 68,426 treatment-naive patients.
- Outcome Measurement: Primary outcome was the initiation of dapagliflozin or empagliflozin during 2023, analyzed using multilevel logistic regression.
Key Findings:
- Only 14.2% of participants initiated SGLT2 inhibitors in 2023.
- Newly coded heart failure patients had over twice the odds of initiating treatment.
- Demographic factors such as female sex, pension status, family insurance, and recent relocation were associated with lower initiation rates.
- Higher municipal income tax was linked to a 21% greater likelihood of treatment initiation.
- Type 2 diabetes, chronic kidney disease, obesity, chronic obstructive pulmonary disease, asthma, and receipt of other guideline-directed heart failure drugs were associated with treatment initiation.
Interpretation:
Limitations:
- Study based on administrative claims data, limiting causal inference.
- Lack of clinical variables that may affect prescribing decisions.
- Potential selection bias due to exclusion of patients with missing information.
Conclusion:
Sources:
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