Use of SGLT2i and ARNi in patients with atrial fibrillation and heart failure in 2021–2022: an analysis of real-world data

• Type of Material: Article
• Authors: Alvaro Alonso, Emory University; Alanna Morris, Emory University; Ashley Naimi, Emory University; Aniqa Bushra Alam, Emory University; Linzi Li, Emory University; Vinita Subramanya, Emory University; Lin Yee Chen, University of Minnesota; Pamela L. Lutsey, University of Minnesota
• Language: English
• Date: 2023-09-10
• Publisher: NIH
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.1101%2F2023.09.08.23295280
• Title of Journal or Parent Work: medRxiv
• Grant/Funding Information: This work was supported by the Stephen D. Clements Jr. Chair in Cardiovascular Disease Prevention at the Rollins School of Public Health, Emory University. Dr. Alvaro Alonso was supported by the National Heart, Lung, And Blood Institute (NHLBI) of the National Institutes of Health (NIH) under Award Number K24HL148521 and Dr. Pamela Lutsey under NIH/NHLBI Award Number K24HL159246.
• Keywords: heart failure; SGLT2i; ARNi; atrial fibrillation
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective: To evaluate utilization of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor neprilysin inhibitors (ARNi) in patients with atrial fibrillation (AF) and heart failure (HF). Methods: We analyzed the MarketScan databases for the period 1/1/2021 to 6/30/2022. Validated algorithms were used to identify patients with AF and HF, and to classify patients into HF with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). We assessed the prevalence of SGLT2i and ARNi use overall and by HF type. Additionally, we explored correlates of lower utilization, including demographics and comorbidities. Results: The study population included 60,927 patients (mean age 75, 43% female) diagnosed with AF and HF (85% with HFpEF, 15% with HFrEF). Prevalence of ARNi use was 11% overall (30% in HFrEF, 8% in HFpEF), while 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% (from 22% to 29% in HFrEF, from 6% to 8% in HFpEF), and SGLT2i from 3% to 9% (from 6% to 16% in HFrEF, from 2% to 7% in HFpEF). Female sex, older age, and specific comorbidities were associated with lower utilization of these two medication types overall and by HF type. Conclusion: Use of ARNi and SGLT2i in patients with AF and HF is suboptimal, particularly among females and older individuals, though utilization 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.