摘要

目的：Sodium-glucose cotransporter 2 (SGLT-2) inhibitor 原為第二型糖尿病 (Type 2 diabetes, T2DM) 治療用藥，近年來在心臟衰竭的治療逐漸受到重視，2021 年歐洲心臟學會 (European society of cardiology, ESC) 及2022 年美國心臟協會 (American heart association, AHA) 心衰竭治療指引也將其納入HFrEF (heart failure with reduced ejection fraction) 的一線用藥， 本研究分析本院醫師對HFrEF 族群開立SGLT-2 inhibitor 的處方行為。
 

方法：本研究為回溯性研究，使用2021 年4 月至2024 年2 月南部單一醫學中心心衰竭用藥提示系統資料，研究對象為心衰竭住院病人，研究期間內每次住院皆計算為一筆資料，回顧其住院前三個月雲端藥歷及出院當日之處方，進行相關分析。
 

結果：本研究納入心衰竭病人共2,326 人，排除無法取得LVEF (left ventricular ejection fraction) 者共494 人，剩餘1,832 人進入分析。平均年齡71 歲，男性共1,020 人 (55.7%)， 女性812 人 (44.3%)， 其中HFrEF 共 613 人 (33.5%)，HFmrEF (heart failure with mildly reduced ejection fraction) 222 人 (12.1%)，HFpEF (heart failure with preserved ejection fraction) 997 人 (54.4%)。HFrEF 合併T2DM (type 2 diabetes) 且有使用SGLT-2 inhibitor 共193 人，其中dapagliflozin 131 人 (67.9%)，empagliflozin 60 人 (31.1%)，canagliflozin 2 人 (1.0%)。本院HFrEF 使用SGLT-2 inhibitor 開立率呈現上升趨勢，截至2023 年9 月至2024 年2 月區間，HFrEF 合併T2DM 的SGLT-2 inhibitor 開立率由38.1% 上升至84.1%，HFrEF 未合併T2DM 由8.8% 上升至57.1%。在HFrEF 合併T2DM 族群當中，有66% 病人有使用SGLT-2 inhibitor，34% 有使用DPP-4 inhibitor，32.7% 有使用metformin。
 

結論：本研究探討醫師對HFrEF 病人開立SGLT-2 inhibitor 的處方行為，結果顯示此類藥品開立率逐年上升，顯示臨床醫師之處方型態已逐漸趨近臨床指引建議，期待未來能進行心衰竭預後相關指標，如再住院率、死亡率的探討，以提供醫療人員更完整的資訊。

 

ABSTRACT

Objective: Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, initially used for type 2 diabetes (T2DM), have recently been recommended as first-line therapy for HFrEF (heart failure with reduced ejection fraction) by the 2021 ESC (European society of cardiology) and 2022 AHA (American heart association) guidelines. This study aimed to analyze the prescribing patterns of SGLT-2 inhibitors for HFrEF patients at a single medical center in southern Taiwan.
 

Methods: A retrospective study using data from a heart failure medication alert system (Apr 2021–Feb 2024) was conducted. All hospitalizations were included, and outpatient prescriptions within three months prior to admission and at discharge were reviewed.
 

Results: Among 1,832 patients with available LVEF (left ventricular ejection fraction) data, 33.5% had HFrEF. SGLT-2 inhibitor use increased over time, from 38.1% to 84.1% in HFrEF with T2DM, and from 8.8% to 57.1% without T2DM. Dapagliflozin was most commonly prescribed.
 

Conclusion: SGLT-2 inhibitor prescribing for HFrEF has risen steadily and exceeds international rates, suggesting improved guideline adherence. Further studies on clinical outcomes such as rehospitalization and mortality are warranted.

 

 

Submitted for publication: 2025.04.22; Accepted for publication: 2025.09.30