Encore Presentations
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Purpose: Sodium glucose co-transporter-2 (SGLT2) inhibitors represent the newest medication class making up the backbone of guideline directed medical therapy for patients with heart failure. Despite known benefits of SGLT2 inhibitors related to morbidity and mortality in patients with heart failure, encountering patients who are not prescribed these therapies is common. Additionally, there may be hesitancy to prescribe these medications in the hospital due to unknown outpatient cost or side effect concerns. The purpose of this evaluation was to describe the prescribing patterns and common reasons for discontinuation of SGLT2 inhibitors in hospitalized patients with heart failure.
Methods: This was a retrospective, single-center drug-use evaluation of SGLT2 inhibitor prescribing patterns for adult patients discharged from the inpatient heart failure service. Patients were excluded if they had a history of left ventricular assist device implantation or heart transplant, leaving against medical advice, or patients expiring during admission. At our institution, clinical pharmacists rounded with the cardiology fellow and heart failure cardiologist and provided medication optimization recommendations for GDMT after clinical review and cost assessment. Institutional review board deemed this evaluation as exempt. The primary outcome was the percentage of patients who were discharged on an SGLT2 inhibitor. Secondary outcomes included number of cost assessments for SGLT2 inhibitor, number of patients prescribed an SGLT2 inhibitor at discharge for whom SGLT2 inhibitor cost was assessed, and reasons patients had SGLT2 inhibitor discontinued or not initiated during admission.
Results: A total of 595 patients admitted to the heart failure service between April 4, 2022 and December 31, 2022 were evaluated. A total of 316 patients (53.1%) were either initiated or continued SGLT2 inhibitor therapy at the time of discharge. Of them, 135 (22.7%) patients were newly initiated and 181 patients (30.4%) continued on therapy at the time of discharge. Medication cost assessment was performed for 176 patients (29.6%). Of patients who received a cost assessment, 95 patients (54%) were initiated on SGLT2 inhibitor, 14 patients (8%) continued therapy, and 67 patients (38%) were not initiated on therapy. The most common reasons documented for why SGLT2 inhibitor was not initiated or discontinued included renal dysfunction, cost, urinary tract infection history or treatment during hospitalization, hypotension, discharge to hospice/palliative care, or other/unspecified. Renal function was the reason for approximately one-third of the patients to not receive SGLT2 inhibitor at discharge with 18.3% of those being due to advanced chronic kidney disease or intermittent hemodialysis requirements.
Conclusion: SGLT2 inhibitors are frequently prescribed, however, this drug-use evaluation demonstrates common reasons for initiation hesitancy or discontinuation in a hospitalized patient population. Pharmacists can assist with optimization of patient therapy as demonstrated by the almost one in four patients initiated on an SGLT2 inhibitor and performance of cost assessment. Acute changes in renal function, advanced chronic kidney disease, and high medication costs are all primary drivers of SGLT2 inhibitor prescription inertia.
Presenting Author
Julianne Fallon PharmDCleveland Clinic
Authors
Emily McElhaney PharmD
Cleveland Clinic