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Impact of Inpatient Initiation of Sodium-Glucose Cotransporter-2 Inhibitors on Prescription Rates in Patients With

Henry Okoroike1, Sajni Patel1, Pamela Simone1

  • 1Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois.

The American Journal of Cardiology
|October 25, 2022
PubMed

Insights

Initiating sodium-glucose cotransport-2 (SGLT2) inhibitors during hospitalization for heart failure with reduced ejection fraction (HFrEF) significantly increases post-discharge medication adherence. This approach also reduces 30-day heart failure readmissions, improving patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Guideline-directed medical treatment (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains suboptimal despite evidence from large trials.
  • Sodium-glucose cotransport-2 (SGLT2) inhibitors represent a critical class of medications for HFrEF management.
  • Inpatient initiation of therapies may overcome barriers to outpatient prescribing and improve adherence.

Purpose of the Study:

  • To assess the impact of inpatient initiation of SGLT2 inhibitors on post-discharge prescription rates in HFrEF patients.
  • To evaluate the effect of inpatient SGLT2 inhibitor initiation on 30-day clinical outcomes, including heart failure readmissions and cardiovascular mortality.

Main Methods:

  • Retrospective analysis of hospitalized patients (n=2,663) with left ventricular ejection fraction (LVEF) ≤40% from July 2020 to July 2021.
  • Comparison of SGLT2 inhibitor prescription rates at 30 days post-discharge between patients who initiated therapy during hospitalization versus those who did not.
  • Assessment of 30-day heart failure readmission rates and cardiovascular mortality between the two groups.

Main Results:

  • Inpatient SGLT2 inhibitor initiation was low (6.6%), but significantly increased 30-day post-discharge prescription rates (96% vs. 14.7%, p <0.0001).
  • Patients with inpatient SGLT2 inhibitor initiation had significantly lower 30-day heart failure readmission rates (9.3% vs. 22.7%, p=0.04).
  • Cardiovascular mortality showed a numerical, but not statistically significant, difference between groups (4% vs. 10.7%, p=0.21).

Conclusions:

  • Inpatient initiation of SGLT2 inhibitors is associated with substantially higher post-discharge adherence to these vital HFrEF medications.
  • This strategy significantly reduces early heart failure readmissions, highlighting its clinical utility.
  • Initiating SGLT2 inhibitors during hospitalization is a key strategy to improve the quality of care for HFrEF patients.

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