Late Breaking Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been shown to alter adverse cardiac outcomes such as left ventricular remodeling, progression to heart failure and recurrent myocardial infarction. However, despite well-established cardiovascular benefits and guideline endorsement, prescribing remains low amongst patients with cardiovascular disease and diabetes.
Research Question or Hypothesis: We propose that the initiation of an SGLT-2i in the post-percutaneous coronary intervention (PCI) population provides patients with the best opportunity for medication adherence and improvement of hemoglobin A1c goal, through a systematic, pharmacist-initiated mechanism perioperatively.
Study Design: This was a pilot study where patients with diabetes undergoing planned PCI were screened for and prescribed SGLT-2i immediately following their PCI procedure.
Methods: Pharmacists screened patients for SGLT-2i candidacy prior to scheduled PCI procedures. Patients were included if they had coronary disease requiring PCI, T2DM with a hemoglobin A1c = 6.5, and followed by providers within the same healthcare system as the interventional cardiologists. Patients with heart failure, insulin-dependent, eGFR < 30 ml/min/1.73m2 or uninsured were excluded. Barriers to SGLT-2i initiation were captured. Patients were assessed 3 days, 1-month, and 3-months post-PCI to address medication concerns such as abnormal lab values and side effects and to evaluate medication adherence.
Results: Between October 2022 to February 2023, ~500 patients were screened. Less than 5% of patients were candidates for SGLT-2i, however, 90% of these candidates were prescribed SGLT-2i. Based on prescription dispense data, patients were compliant with medications during the 3-month follow up. No adverse effects were reported, and laboratory values were within normal limits. Insurance requirements with step therapy, financial hardship, follow-up with providers outside healthcare system, and pill burden were identified as the main barriers.
Conclusion: Patients benefit from early initiation of SGLT-2i in this pharmacy-led initiative, but many barriers, particularly with cost and lack of insurance coverage for SGLT-2i in this high risk population, make it difficult to change practice.
Presenting Author
Carrie Bi PharmDScripps Memorial La Jolla Hospital
Authors
Ruth Choi PharmD
Scripps Memorial La Jolla Hospital