This observational cohort study evaluates temporal trends and determinants of sodium-glucose cotransporter 2 inhibitor (SGLT2i) prescriptions among adults with chronic heart failure enrolled in a nationwide remote monitoring program in France between 2021 and 2024. The analysis examines SGLT2i use at the time of enrollment in relation to left ventricular ejection fraction subgroups and evolving scientific evidence, including major clinical trial publications and guideline updates. Demographic, clinical, and healthcare setting factors associated with SGLT2i prescription in routine clinical practice are assessed using retrospective data from the remote monitoring program database. No study-mandated interventions were performed, and all treatments were prescribed as part of usual care.

This retrospective, multicenter observational cohort study was conducted in France between January 1, 2021 and December 31, 2024 within a nationwide heart failure (HF) remote monitoring program. The study included adult patients with chronic heart failure enrolled in the program following hospitalization for HF or in the ambulatory setting with elevated natriuretic peptide levels.

The remote monitoring program supports routine HF management using a digital platform that enables structured follow-up and communication between patients and healthcare providers. Clinical and treatment data recorded at the time of enrollment were extracted from the program database for analysis.

The primary objective of the study is to describe the prevalence of sodium-glucose cotransporter 2 inhibitor (SGLT2i) use at enrollment. Secondary objectives include evaluation of temporal trends in SGLT2i prescriptions across predefined time periods corresponding to major clinical trial publications and guideline updates, and identification of demographic, clinical, and healthcare setting factors associated with SGLT2i use.

Analyses focus on medication use as part of routine clinical care. No study-specific interventions were assigned, and all treatments were prescribed at the discretion of the treating clinicians. Statistical analyses include descriptive methods and multivariable regression modeling to assess factors independently associated with SGLT2i prescription.

Inclusion Criteria:

• Age 18 years or older
• Diagnosis of chronic heart failure
• Enrolment in the national heart failure remote monitoring program between January 2021 and December 2024
• Enrolment following hospitalization for heart failure or in the ambulatory setting with elevated natriuretic peptide levels consistent with program eligibility criteria

Exclusion Criteria:

- Missing baseline medication data at the time of program enrolment

The study population includes adults with chronic heart failure in France who were enrolled in a nationwide remote patient monitoring program between January 2021 and December 2024 as part of routine clinical care. Enrollment typically followed hospitalization for heart failure or occurred in ambulatory patients with elevated natriuretic peptide levels consistent with heart failure management guidelines. The cohort represents patients managed across a range of healthcare settings, including university hospitals, non-university hospitals, and outpatient practices.