Recorded Adoption of SGLT2 Inhibitors from 2022 to 2025 Among Adults with an EHR-Defined HFrEF Phenotype at a Jordanian Public Hospital

Background/Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are foundational therapy for heart failure with reduced ejection fraction (HFrEF), irrespective of diabetes. We evaluated recorded SGLT2i adoption and diabetes-related differences among adults with an electronic health record (EHR)-defined HFrEF phenotype at a Jordanian public hospital.

Methods

This retrospective Hakeem cohort included 1750 adults. The frozen HFrEF phenotype was internally validated in an independent non-overlapping sample, and SGLT2i ascertainment was verified by complete-cohort medication review. Comparable annual analyses covered 2022–2025, when medication-source completeness exceeded 90%. Secondary analyses examined first recorded use after a 180-day lookback, concurrent four-class guideline-directed medical therapy (GDMT) in 2025, measured-eGFR threshold cohorts, and prespecified Firth regression among patients with type 2 diabetes (T2DM). Additional sensitivity analyses included a stable four-year cohort, a time-to-first-record analysis with explicit censoring, expanded model diagnostics with a time-to-event sensitivity analysis, and a strict directly documented-coverage GDMT analysis.