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Prescribing patterns of SGLT-2 inhibitors for patients with heart failure: A two-center analysis
Teja Chakrala1, Roshni O Prakash1, Justin Kim1
1Department of Medicine, University of Florida, Gainesville, FL, United States of America.
Insights
Sodium glucose co-transporter 2 inhibitors (SGLT2i) show low prescription rates in heart failure patients despite proven benefits. This study identifies barriers to SGLT2i implementation in clinical practice.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Practice
Background:
- Sodium glucose co-transporter 2 inhibitors (SGLT2i) reduce cardiovascular death and hospitalizations in heart failure (HF) patients, regardless of diabetes status.
- Despite strong recommendations, SGLT2i prescription rates for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) remain low.
Purpose of the Study:
- To analyze SGLT2i prescription patterns at two academic institutions.
- To identify barriers hindering the implementation of SGLT2i in heart failure management.
Main Methods:
- Retrospective analysis of patients (≥18 years) diagnosed with heart failure admitted between May 2021 and May 2022.
- Inclusion criteria: eGFR ≥20 mL/min/1.73m², BNP ≥100 pg/mL.
- Data collected on SGLT2i prescription rates and associated factors.
Main Results:
- SGLT2i prescribed in only 1.8% of HFpEF and 3.2% of HFrEF patients.
- Cardiologist approval was required for most HFpEF SGLT2i prescriptions from general medicine.
- No significant association found between SGLT2i use and adverse events like hypoglycemia or UTIs.
Conclusions:
- Implementation of SGLT2i in heart failure management is significantly low despite established efficacy.
- Barriers to SGLT2i uptake in clinical practice require further investigation and intervention.
Background:
Sodium glucose co-transporter 2 inhibitors (SGLT2i) have been proven to reduce the combined risk of cardiovascular death and hospitalizations in patients with heart failure (HF), irrespective of the presence or absence of diabetes. Despite class 1 and class 2A recommendations for their usage in HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) respectively by the American College of Cardiology, their prescription rate has remained low.
Objective:
The aim of this study is to analyze SGLT2i prescription patterns at two academic institutions, with the goal of identifying barriers to implementation.
Design:
A two-center retrospective analysis was conducted on patients ≥18 years old with a diagnosis of heart failure who were admitted to one of two hospital systems between 5/1/21 and 5/31/22. Patients with an eGFR ≥20 mL/min/1.73m2 and BNP ≥ 100 pg/mL were included.
Results:
SGLT2i was prescribed in only 19 out of 1081 HFpEF patients (1.8 %) and 51 out of 1596 HFrEF patients (3.2 %). A majority of SGLT2i prescriptions for the HFpEF population came from general medicine services (57.9 %) after obtaining approval from a cardiologist, which was required at our institutions. Adverse effects such as hypoglycemia and urinary tract infections were not significantly associated with SGLT2i use.
Conclusions:
Despite proven benefits of this class of medications as witnessed in large-scale clinical trials, the implementation of this drug class continues to be low.
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