Predictors of Sodium Glucose Co-Transporter-2 Inhibitor Utilization in Elderly Heart Failure Patients: A Real-World Population-Level Dataset Analysis

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated robust cardiovascular benefits in patients with heart failure (HF), yet disparities in their real-world utilization remain unclear. Our study aims to evaluate predictors of SGLT2i prescription and identify sociodemographic disparities among HF patients. A retrospective cohort study was conducted using the Texas Medicare dataset between January 2017 and June 2022 to evaluate factors associated with SGLT2i prescription among HF patients. Descriptive statistics were used to compare baseline characteristics between groups, and multivariable logistic regression reported independent predictors of SGLT2i prescription. Adjusted marginal probabilities of SGLT2i use were estimated across racial/ethnic groups. Of 309,577 HF patients, those prescribed SGLT2i were less likely to be ≥80 years (16.9% vs 44%), female (45.7% vs 57.4%), and Non-Hispanic Whites (64.1% vs 75.1%) compared to those not prescribed SGLT2i. Diabetes (aOR: 4.66, 95% CI: 4.45–4.87), hypertension (aOR: 1.09, 95% CI: 1.01–1.18), and obesity (aOR: 1.35, 95% CI: 1.29–1.41) were strongly associated with higher odds of prescription, while CKD stage III and IV, peripheral vascular disease, and urinary tract infection were associated with significantly lower odds. Adjusted probability of SGLT2i prescription was highest among Asians (3.96%) and lowest among Blacks (2.26%). In conclusion, significant disparities exist in SGLT2i prescription among HF patients, particularly by age, race/ethnicity, and comorbidity burden. Efforts to promote equitable access to guideline-directed medical therapy are warranted to reduce disparities in HF care.