不同性别在开具 SGLT2 抑制剂处方方面的差异

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY Journal of clinical lipidology Pub Date : 2024-07-01 DOI:10.1016/j.jacl.2024.04.044
Rahul Rege MD, Spencer Weintraub MD, Benjamin Hirsh MD, Christian Leung MD
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引用次数: 0

摘要

背景/简介近年来,钠-葡萄糖共转运体-2 抑制剂(SGLT2i)在心血管和肾脏预后方面都显示出显著的疗效,这导致医疗机构的使用率增加,并被纳入社会指南。随着 SGLT2i 使用范围的扩大,可能会出现处方做法的差异。目标/目的确定充血性心力衰竭(CHF)或慢性肾病(CKD)不同性别患者的 SGLT2i 处方做法差异。方法对纽约州诺斯韦尔健康系统内 2018 年至 2023 年期间处方 SGLT2i 的所有患者进行横断面分析。从电子病历中检索了人口统计学数据,包括种族、性别、CHF 和 CKD 的 ICD-10 编码以及最后记录的 GFR。如果患者的 ICD-10 编码为 CKD 或 GFR 在 30-60 之间,则被视为具有 SGLT2i 适当适应症的 CKD 患者。然后将该数据与 2021 年秋季医疗保险当前受益人调查 (MCBS) 中报告的男性和女性 CHF 和 CKD 患病率进行比较。结果从 2018 年到 2023 年,在 11,290 名处方 SGLT2i 的患者中,12.7% 的患者患有 CHF,10.5% 的患者患有 CKD。在 CHF 患者中,27.6% 为女性;在 CKD 患者中,33.9% 为女性。在 MCBS 中,女性占 CHF 患者的 48.9%,占 CKD 患者的 51.9%。结论虽然根据 MCBS,CHF 和 CKD 患者的男女比例大致相同,但我们的数据表明,女性接受 SGLT2i 治疗的人数较少。这种差异可能是因为纽约州男性和女性的 CHF 和 CKD 患病率不同,女性更有可能患有 SGLT2i 的禁忌症,或者是系统性偏差。另外,考虑到美国食品药品管理局(FDA)关于泌尿生殖系统感染风险增加的警告,处方医生可能会犹豫是否给女性开 SGLT2i。最终,这项研究揭示了在开具 SGLT2i 处方时,男性和女性之间可能存在潜在的偏差,进一步的研究和提高临床医生的认识将使我们受益匪浅。
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Discrepancies in Prescribing Practices for SGLT2 Inhibitors Between Sexes

Background/Synopsis

In recent years, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in both cardiovascular and renal outcomes, which has resulted in increased provider utilization and inclusion into society guidelines. As the use of SGLT2i expands, variations in prescribing practices may arise.

Objective/Purpose

To identify variations in prescribing practices in SGLT2i among patients of different sex with either congestive heart failure (CHF) or chronic kidney disease (CKD).

Methods

A cross-sectional analysis of all patients prescribed SGLT2i between 2018 and 2023 within the Northwell Health system in New York State was conducted. Demographic data, including race, sex, ICD-10 codes for CHF and CKD, and last documented GFR, were retrieved from the electronic medical record. Patients were considered to have CKD with an appropriate indication for SGLT2i if they had an ICD-10 code for CKD or a GFR between 30 and 60. This data was then compared to the prevalence of CHF and CKD in men and women as reported in the Medicare Current Beneficiaries Survey (MCBS) of Fall 2021.

Results

From 2018 to 2023, of the 11,290 patients were prescribed SGLT2i, 12.7% had CHF and 10.5% had CKD. Of the patients with CHF, 27.6% were women, and of the patients with CKD, 33.9% were women. Within MCBS, women comprised 48.9% of patients with CHF and 51.9% of patients with CKD.

Conclusions

While according to MCBS, CHF and CKD affect men and women in approximately equal proportions, our data suggests that less women were prescribed SGLT2i. This discrepancy may represent different prevalence of CHF and CKD in men and women in New York State, contraindications to SGLT2i that are more likely to be present in women, or a systematic bias. Alternatively, prescribers may be hesitant to prescribe SGLT2i to women, given the FDA warning regarding increased risk of genitourinary infections. Ultimately, this study reveals a potential underlying bias in prescribing practices for SGLT2i between men and women that would benefit from further study and enhanced clinician awareness.

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来源期刊
CiteScore
7.00
自引率
6.80%
发文量
209
审稿时长
49 days
期刊介绍: Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.
期刊最新文献
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