General physicians' perspectives on SGLT2 inhibitors for heart failure

Area of Science:

• Cardiology
• Pharmacology
• General Medicine

Background:

• Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are emerging treatments for heart failure (HF).
• Guidelines now recommend SGLT2is for HF management.
• Understanding general physicians' (GPs) perspectives is key to optimizing SGLT2i use.

Purpose of the Study:

• To investigate clinical concerns and barriers faced by GPs when prescribing SGLT2is.
• To assess GPs' perspectives on SGLT2i utilization in a general medicine setting.

Main Methods:

• A questionnaire survey was distributed to members of the Internal Medicine Society of Australia and New Zealand.
• The survey explored GPs' experience, comfort, and barriers regarding SGLT2i prescribing for HF patients.
• Two clinical scenarios were included to gauge practical application.

Main Results:

• A low response rate (10.8%) yielded 98 participants, mostly senior staff in metropolitan public hospitals.
• Prescribing rates for SGLT2is varied: 23.5% frequently for HF with reduced ejection fraction, and 57.1% less than 25% of the time for HF with preserved ejection fraction.
• While familiarity with SGLT2i therapeutics (44%) and side effects (47%) was high, key barriers included patient complexity, medication cost, and care discontinuity. Euglycemic diabetic ketoacidosis was a major concern for 48%.

Conclusions:

• GPs in Australia and Aotearoa New Zealand possess good knowledge of SGLT2i therapy and potential side effects.
• Significant barriers to SGLT2i adoption for HF include patient-related factors, medication expenses, and fragmented healthcare delivery.
• Addressing these barriers is crucial for improving SGLT2i implementation in primary care for HF.