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Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement
Ahmad Karzoun1, Hamza Alkowatli1, Olu Oyesanmi2
1Department of Internal Medicine, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA.
Background:
Despite strong evidence supporting dapagliflozin 10 mg daily for heart failure with reduced ejection fraction, variation in prescribing practices persists.
Project Rationale:
Institutional review identified frequent use of non-guideline-supported dapagliflozin 5 mg dosing and demonstrated that inpatient dose selection strongly influenced discharge prescribing patterns.
Project Summary:
A multidisciplinary quality improvement intervention consisting of electronic medical record redesign, provider education, and pharmacist-led discharge verification was implemented on December 15, 2025. Among 124 preintervention patients, 83.9% received inpatient dapagliflozin 10 mg and 16.1% received 5 mg. Following intervention, guideline-concordant 10-mg prescribing increased to 92.0% and 5-mg prescribing decreased to 8.0%. Inpatient dose remained significantly associated with discharge prescribing behavior (P = 0.0467).
Take-Home Messages:
System-level workflow redesign improved adherence to guideline-concordant dapagliflozin prescribing and reduced non-evidence-based low-dose use. Similar implementation strategies may improve delivery of guideline-directed medical therapy in heart failure.
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