---
title: "Real-world uptake of SGLT2 inhibitors in heart failure across ejection fraction: Swedish registry"
id: "pubmed-42001463"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42001463"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42001463/"
doi: "10.1093/ehjqcco/qcag063"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Real-world uptake of SGLT2 inhibitors in heart failure across ejection fraction: Swedish registry
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42001463
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42001463/)
- **DOI:** [10.1093/ehjqcco/qcag063](https://doi.org/10.1093%2Fehjqcco%2Fqcag063)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study used the Swedish Heart Failure Registry (SwedeHF) to assess real-world implementation of **SGLT2 inhibitors (SGLT2i)** in patients with heart failure enrolled between 1 September 2022 and 16 December 2024. - The cohort included 24,578 patients (median age 75 years, interquartile range 65–81; 33% female) stratified by ejection fraction: **HFrEF** 43%, **HFmrEF** 31%, **HFpEF** 26%. - During the study period SGLT2i use rose markedly: from 78% to 89% in HFrEF, from 54% to 80% in HFmrEF, and from 41% to 80% in HFpEF by December 2024. - Independent predictors of SGLT2i use included male sex, prior HF hospitalization within the past year, impaired kidney function, obesity, higher socioeconomic profile, and concurrent beta-blocker treatment. - Follow-up in specialist care was associated with higher SGLT2i use in **HFrEF** and **HFmrEF**. - Type 2 diabetes (T2DM) was independently associated with SGLT2i use across all EF groups, with a stronger association in **HFpEF**. - Use of RAAS inhibitors and MRAs correlated with higher SGLT2i use across EF, with stronger associations in **HFrEF** and **HFmrEF** for RAAS inhibitors; MRAs showed similar patterns but stronger in HFrEF/HFmrEF. - By the end of the observation period SGLT2i implementation was near 90% in HFrEF and about 80% in HFmrEF and HFpEF, indicating rapid clinical adoption but remaining gaps for certain subgroups (women, HFpEF without T2DM, primary care follow-up, lower socioeconomic status).
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42001463/#linkout) Title & authors Abstract Plain language summary Comment in Similar articles Cited by MeSH terms Substances Related information Grants and funding LinkOut - more resources Eur Heart J Qual Care Clin Outcomes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42001463/) . 2026 Sep 16;12(6):947-961. doi: 10.1093/ehjqcco/qcag063. # Implementation of sodium-glucose co-transporter 2 inhibitors use in patients with heart failure across the ejection fraction: data from the Swedish heart failure registry [Giulia Ferrannini](https://pubmed.ncbi.nlm.nih.gov/?term=Ferrannini+G&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-2 "Internal Medicine Unit, Södertälje Hospital, Rosenborgsgatan 10, 152 40 Södertälje, Sweden."), [Francesca Musella](https://pubmed.ncbi.nlm.nih.gov/?term=Musella+F&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-4 "Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy."), [Lina Benson](https://pubmed.ncbi.nlm.nih.gov/?term=Benson+L&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Valeria Valente](https://pubmed.ncbi.nlm.nih.gov/?term=Valente+V&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Felix Lindberg](https://pubmed.ncbi.nlm.nih.gov/?term=Lindberg+F&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Marco Boccalatte](https://pubmed.ncbi.nlm.nih.gov/?term=Boccalatte+M&cauthor_id=42001463)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-4 "Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy."), [Carin Corovic Cabrera](https://pubmed.ncbi.nlm.nih.gov/?term=Corovic+Cabrera+C&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Ulf Dahlström](https://pubmed.ncbi.nlm.nih.gov/?term=Dahlstr%C3%B6m+U&cauthor_id=42001463)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-5 "Department of Health, Medicine and Caring Sciences Linköping University, Lasarettsgatan 12, 582 25 Linköping, Sweden."), [Lars H Lund](https://pubmed.ncbi.nlm.nih.gov/?term=Lund+LH&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden."), [Davide Stolfo](https://pubmed.ncbi.nlm.nih.gov/?term=Stolfo+D&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-6 "Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale and University Hospital of Udine, via Pozzuolo 330, 33100 Udine, Italy."), [Gianluigi Savarese](https://pubmed.ncbi.nlm.nih.gov/?term=Savarese+G&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#full-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.") Affiliations Expand ### Affiliations * 1 Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden. * 2 Internal Medicine Unit, Södertälje Hospital, Rosenborgsgatan 10, 152 40 Södertälje, Sweden. * 3 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden. * 4 Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy. * 5 Department of Health, Medicine and Caring Sciences Linköping University, Lasarettsgatan 12, 582 25 Linköping, Sweden. * 6 Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale and University Hospital of Udine, via Pozzuolo 330, 33100 Udine, Italy. * PMID: **42001463** * DOI: [ 10.1093/ehjqcco/qcag063 ](https://doi.org/10.1093/ehjqcco/qcag063) Free article Item in Clipboard # Implementation of sodium-glucose co-transporter 2 inhibitors use in patients with heart failure across the ejection fraction: data from the Swedish heart failure registry Giulia Ferrannini et al. Eur Heart J Qual Care Clin Outcomes. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Qual Care Clin Outcomes Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J+Qual+Care+Clin+Outcomes%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42001463/) . 2026 Sep 16;12(6):947-961. doi: 10.1093/ehjqcco/qcag063. ### Authors [Giulia Ferrannini](https://pubmed.ncbi.nlm.nih.gov/?term=Ferrannini+G&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-2 "Internal Medicine Unit, Södertälje Hospital, Rosenborgsgatan 10, 152 40 Södertälje, Sweden."), [Francesca Musella](https://pubmed.ncbi.nlm.nih.gov/?term=Musella+F&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-4 "Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy."), [Lina Benson](https://pubmed.ncbi.nlm.nih.gov/?term=Benson+L&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Valeria Valente](https://pubmed.ncbi.nlm.nih.gov/?term=Valente+V&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Felix Lindberg](https://pubmed.ncbi.nlm.nih.gov/?term=Lindberg+F&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Marco Boccalatte](https://pubmed.ncbi.nlm.nih.gov/?term=Boccalatte+M&cauthor_id=42001463)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-4 "Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy."), [Carin Corovic Cabrera](https://pubmed.ncbi.nlm.nih.gov/?term=Corovic+Cabrera+C&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden."), [Ulf Dahlström](https://pubmed.ncbi.nlm.nih.gov/?term=Dahlstr%C3%B6m+U&cauthor_id=42001463)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-5 "Department of Health, Medicine and Caring Sciences Linköping University, Lasarettsgatan 12, 582 25 Linköping, Sweden."), [Lars H Lund](https://pubmed.ncbi.nlm.nih.gov/?term=Lund+LH&cauthor_id=42001463)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-1 "Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden."), [Davide Stolfo](https://pubmed.ncbi.nlm.nih.gov/?term=Stolfo+D&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-6 "Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale and University Hospital of Udine, via Pozzuolo 330, 33100 Udine, Italy."), [Gianluigi Savarese](https://pubmed.ncbi.nlm.nih.gov/?term=Savarese+G&cauthor_id=42001463)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42001463/#short-view-affiliation-3 "Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden.") ### Affiliations * 1 Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 111 11 Stockholm, Sweden. * 2 Internal Medicine Unit, Södertälje Hospital, Rosenborgsgatan 10, 152 40 Södertälje, Sweden. * 3 Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden. * 4 Cardiology Department, Santa Maria Delle Grazie Hospital, Via Domiziana, Localitá La Schiana, 80078 Pozzuoli, Naples, Italy. * 5 Department of Health, Medicine and Caring Sciences Linköping University, Lasarettsgatan 12, 582 25 Linköping, Sweden. * 6 Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale and University Hospital of Udine, via Pozzuolo 330, 33100 Udine, Italy. * PMID: **42001463** * DOI: [ 10.1093/ehjqcco/qcag063 ](https://doi.org/10.1093/ehjqcco/qcag063) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** The aim of this study was to assess the implementation of sodium-glucose co-transporter-2 inhibitors (SGLT2i) use in a real-world heart failure (HF) cohort. **Methods and results:** Patients from the Swedish HF Registry enrolled 1 September 2022 to 16 December 2024 were included. Characteristics independently associated with SGLT2i use were investigated by multivariable logistic regression models, in the overall cohort and stratified by ejection fraction (EF).Of 24 578 patients (median age [Q1-Q3]:75 [65-81] years, 33% female), 43% had HF with reduced EF(HFrEF), 31% had HF with mildly reduced EF(HFmrEF), and 26% had HF with preserved EF(HFpEF). During the study period, SGLT2i use increased from 78% to 89% in HFrEF, from 54% to 80% in HFmrEF, and from 41% to 80% in HFpEF.Independent predictors of SGLT2i use included male sex, HF hospitalization during the past year, impaired kidney function, obesity, higher socioeconomic profile, and beta-blocker use. Follow-up in specialist care was associated with higher use in HFrEF and HFmrEF. Type 2 diabetes (T2DM) was independently associated with use across EF, with a stronger association in HFpEF. Renin-angiotensin-aldosterone system inhibitors were associated with SGLT2i use across the EF spectrum, with stronger associations in HFrEF and HFmrEF, while mineralocorticoid receptor antagonists showed similar associations across EF categories, stronger in HFrEF and HFmrEF. **Conclusion:** SGLT2i were rapidly implemented in clinical practice, with their use reaching ∼90% in HFrEF and approaching a plateau at ∼80% in HFmrEF and HFpEF in December 2024. There is still room for treatment optimization, particularly among women, patients with HFpEF without T2DM, those followed in primary care, and with lower socioeconomic status. **Keywords:** Ejection fraction; Heart failure; Implementation; Registry; Sodium-glucose co-transporter 2 inhibitors; SwedeHF. ## Plain language summary This study examined how a relatively new class of medications for heart failure (HF), named SGLT2 inhibitors (SGLT2i), are used in daily clinical practice in Sweden. These medications have been shown to help patients with HF to live better and longer, and the researchers wanted to assess how
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