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Impact of Inpatient Initiation of Sodium-Glucose Cotransporter-2 Inhibitors on Prescription Rates in Patients With Heart Failure With Reduced Ejection Fraction

Published:October 22, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.09.019
      Despite large, randomized controlled trials and guideline recommendations, patients with heart failure with reduced ejection fraction (HFrEF) continue to receive suboptimal guideline-directed medical treatment (GDMT). This study aimed to evaluate the potential effect of inpatient initiation of sodium-glucose cotransport-2 (SGLT2) inhibitors on postdischarge prescribing rates and the downstream impact on clinical outcomes. The INitiation of SGlt2i in Hospital for HFrEF (INSIGHT-HF) study was a retrospective analysis of hospitalized patients older than 18 years with a left ventricular ejection fraction (LVEF) ≤40% conducted from July 2020 and July 2021. Our primary outcome was SGLT2i prescription rates at 30 days. Among 2,663 eligible patients with documented HFrEF, 177 (6.6%) had SGLT2i initiated during their index hospitalization. The rate of SGLT2i prescriptions at 30 days was significantly higher in those with inpatient initiation of SGLT2i compared with those who did not start while inpatient (96% vs 14.7%, p <0.0001). The heart failure readmission rate in the first 30 days was significantly lower in those with inpatient initiation of SGLT2i compared with those who did not start during hospitalization. (9.3% vs 22.7%, p = 0.04). Cardiovascular mortality was numerically, but not significantly, different between groups (4% vs 10.7%, p = 0.21). Inpatient initiation of an SGLT2i was associated with a significantly higher postdischarge rate of SGLT2i prescriptions and significantly lower heart failure readmission rates at 30 days. In conclusion, these findings highlight the importance of initiating SGLT2i during inpatient hospitalization to improve the quality of care in patients with HFrEF.
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      References

        • Rådholm K
        • Figtree G
        • Perkovic V
        • Solomon SD
        • Mahaffey KW
        • Zeeuw D de
        • Fulcher G
        • Barrett TD
        • Shaw W
        • Desai M
        • Matthews DR
        • Neal B
        Canagliflozin and heart failure in type 2 diabetes mellitus: results from the CANVAS Program.
        Circulation. 2018; 138: 458-468
        • Martinez FA
        • Serenelli M
        • Nicolau JC
        • Petrie MC
        • Chiang CE
        • Tereshchenko S
        • Solomon SD
        • Inzucchi SE
        • Køber L
        • Kosiborod MN
        • Ponikowski P
        • Sabatine MS
        • DeMets DL
        • Dutkiewicz-Piasecka M
        • Bengtsson O
        • Sjöstrand M
        • Langkilde AM
        • Jhund PS
        • McMurray JJV
        Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights From DAPA-HF.
        Circulation. 2020; 141: 100-111
        • Packer M
        • Anker SD
        • Butler J
        • Filippatos G
        • Pocock SJ
        • Carson P
        • Januzzi J
        • Verma S
        • Tsutsui H
        • Brueckmann M
        • Jamal W
        • Kimura K
        • Schnee J
        • Zeller C
        • Cotton D
        • Bocchi E
        • Böhm M
        • Choi DJ
        • Chopra V
        • Chuquiure E
        • Giannetti N
        • Janssens S
        • Zhang J
        • Gonzalez Juanatey JR
        • Kaul S
        • Brunner-La Rocca HP
        • Merkely B
        • Nicholls SJ
        • Perrone S
        • Pina I
        • Ponikowski P
        • Sattar N
        • Senni M
        • Seronde MF
        • Spinar J
        • Squire I
        • Taddei S
        • Wanner C
        • Zannad F
        • EMPEROR-Reduced Trial Investigators
        Cardiovascular and renal outcomes with empagliflozin in heart failure.
        N Engl J Med. 2020; 383: 1413-1424
        • Voors AA
        • Angermann CE
        • Teerlink JR
        • Collins SP
        • Kosiborod M
        • Biegus J
        • Ferreira JP
        • Michael EN
        • Mitchell A
        • Psotka JT
        • Willem Borleffs CJ
        • Ma C
        • Joseph Comin-Colet MF
        • Stefan P
        • Janssens RG
        • Kiss RJ
        • Sakata Mentz Y
        • Schirmer H
        • Schou Morten
        • Christian Schulze P
        • Spinarova Lenka
        • Volterrani Maurizio
        • Wranicz Jerzy K
        • Zeymer Uwe
        • Zieroth Shelley
        • Brueckmann M
        • Blatchford J
        • Salsali Afshin
        • Ponikowski Piotr
        The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial.
        Nat Med. 2022; 28: 568-574
        • Bhatt DL
        • Szarek M
        • Steg PG
        • Cannon CP
        • Leiter LA
        • McGuire DK
        • Lewis JB
        • Riddle MC
        • Voors AA
        • Metra M
        • Lund LH
        • Komajda M
        • Testani JM
        • Wilcox CS
        • Ponikowski P
        • Lopes RD
        • Verma S
        • Lapuerta P
        • Pitt B
        • SOLOIST-WHF Trial Investigators
        Sotagliflozin in patients with diabetes and recent worsening heart failure.
        N Engl J Med. 2021; 384: 117-128
        • McMurray JJV
        • Solomon SD
        • Inzucchi SE
        • Køber L
        • Kosiborod MN
        • Martinez FA
        • Ponikowski P
        • Sabatine MS
        • Anand IS
        • Bělohlávek J
        • Böhm M
        • Chiang CE
        • Chopra VK
        • Boer RA de
        • Desai AS
        • Diez M
        • Drozdz J
        • Dukát A
        • Ge J
        • Howlett JG
        • Katova T
        • Kitakaze M
        • Ljungman CEA
        • Merkely B
        • Nicolau JC
        • O'Meara E
        • Petrie MC
        • Vinh PN
        • Schou M
        • Tereshchenko S
        • Verma S
        • Held C
        • DeMets DL
        • Docherty KF
        • Jhund PS
        • Bengtsson O
        • Sjöstrand M
        • Langkilde AM
        • DAPA-HF Trial Committees and Investigators
        Dapagliflozin in patients with heart failure and reduced ejection fraction.
        N Engl J Med. 2019; 381: 1995-2008
        • Maddox Thomas M
        • Januzzi James L
        • Allen Larry A
        • Breathett K
        • Butler J
        • Davis Leslie L
        • Fonarow Gregg C
        • Ibrahim Nasrien E
        • Lindenfeld J
        • Masoudi Frederick A
        • Motiwala SR
        • Estefania O
        • Patterson JH
        • Norine WM
        • Wasserman A
        • Yancy Clyde W
        • Youmans Quentin R
        2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues About heart failure With reduced ejection fraction.
        J Am Coll Cardiol. 2021; : 772-810
        • Heidenreich PA
        • Bozkurt B
        • Aguilar D
        • Allen LA
        • Byun JJ
        • Colvin MM
        • Deswal A
        • Drazner MH
        • Dunlay SM
        • Evers LR
        • Fang JC
        • Fedson SE
        • Fonarow GC
        • Hayek SS
        • Hernandez AF
        • Khazanie P
        • Kittleson MM
        • Lee CS
        • Link MS
        • Milano CA
        • Nnacheta LC
        • Sandhu AT
        • Stevenson LW
        • Vardeny O
        • Vest AR
        • Yancy CW.
        2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.
        J Am Coll Cardiol. 2022; 79: 1757-1780
        • Ponikowski P
        • Voors AA
        • Anker SD
        • Bueno H
        • Cleland JGF
        • Coats AJS
        • Falk V
        • González-Juanatey JR
        • Harjola VP
        • Jankowska EA
        • Jessup M
        • Linde C
        • Nihoyannopoulos P
        • Parissis JT
        • Pieske B
        • Riley JP
        • Rosano GMC
        • Ruilope LM
        • Ruschitzka F
        • Rutten FH
        • Meer P van der
        • ESC Scientific Document Group
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        • Ferdinand KC
        • Senatore FF
        • Clayton-Jeter H
        • Cryer DR
        • Lewin JC
        • Nasser SA
        • Fiuzat M
        • Califf RM.
        Improving medication adherence in cardiometabolic disease: practical and regulatory implications.
        J Am Coll Cardiol. 2017; 69: 437-451
        • Ruppar TM
        • Cooper PS
        • Mehr DR
        • Delgado JM
        • Dunbar-Jacob JM.
        Medication adherence interventions improve heart failure mortality and readmission rates: systematic review and meta-analysis of controlled trials.
        J Am Heart Assoc. 2016; 5e002606
        • Vaduganathan M
        • Fonarow GC
        • Greene SJ
        • DeVore AD
        • Kavati A
        • Sikirica S
        • Albert NM
        • Duffy CI
        • Hill CL
        • Patterson JH
        • Spertus JA
        • Thomas LE
        • Williams FB
        • Hernandez AF
        • Butler J.
        Contemporary treatment patterns and clinical outcomes of comorbid diabetes mellitus and HFrEF: the CHAMP-HF registry.
        JACC Heart Fail. 2020; 8: 469-480
        • Carnicelli AP
        • Lippmann SJ
        • Greene SJ
        • Mentz RJ
        • Greiner MA
        • Hardy NC
        • Hammill BG
        • Shen X
        • Yancy CW
        • Peterson PN
        • Allen LA
        • Fonarow GC
        • O'Brien EC
        Sacubitril/Valsartan initiation and postdischarge adherence Among patients hospitalized for heart failure.
        J Card Fail. 2021; 27: 826-836
        • Rao VN
        • Murray E
        • Butler J
        • Cooper LB
        • Cox ZL
        • Fiuzat M
        • Green JB
        • Lindenfeld J
        • McGuire DK
        • Nassif ME
        • O'Brien C
        • Pagidipati N
        • Sharma K
        • Vaduganathan M
        • Vardeny O
        • Fonarow GC
        • Mentz RJ
        • Greene SJ.
        In-hospital initiation of sodium-glucose Cotransporter-2 inhibitors for heart failure With reduced ejection fraction.
        J Am Coll Cardiol. 2021; 78: 2004-2012
        • Butler J
        • Djatche LM
        • Lautsch D
        • Yang L
        • Patel MJ
        • Mentz RJ.
        Representativeness of the Victoria trial population in clinical practice: analysis of the PINNACLE registry.
        J Card Fail. 2021; 27: 1374-1381