Abstract 12558: Sodium-Glucose Cotransporter-2 Inhibitor Quality Improvement Initiative for Guideline-Directed Medical Therapy in Heart Failure (SQUAD-HF)

Abstract

Introduction: Despite efforts encouraging SGLT2i prescriptions at discharge for decompensated heart failure (HF), recent data suggest only 1 in 5 patients receive them with a median odds ratio of 2.5 across hospitals. One of the reasons for under prescription of SGLT2i is cost. Aim: We implemented a comprehensive quality improvement initiative, focusing on education and care coordination, at 2 hospitals, to reduce financial barriers to initiation of SGLT2i prior to discharge. Methods: Interventions were implemented between October 2022 and January 2023. The education component of the intervention included providing residents, fellows, and faculty information regarding the latest HF guidelines, drug profile, and insurance coverage of SGLT2i through multiple modalities like grand rounds, posters, memes, and a dedicated website with links to published research. The care-coordination component of the intervention included similar presentations to pharmacists, social workers, and care coordinators. Best practices including cost checking of SGLT2i earlier during inpatient stay were encouraged throughout the study period. Primary outcome was a change in physician-reported financial barriers to prescription of SGLT2i assessed by a 10-item survey before and after the interventions. Results: Pre- and post-intervention surveys were completed by 82 and 56 healthcare providers; 52% were residents, 8% cardiology fellows, 16% internal medicine attendings, 14% cardiology attendings, and 8% cardiology nurse practitioners respectively. Physicians reported an 18.7% reduction in access and affordability barriers to prescribing SGLT2i for patients admitted with HF, from 86.6% to 67.9% (Table 1). Conclusion: Through a comprehensive education initiative and improving care coordination tailored to the health systems, SQUAD-HF reduced physician-reported access and affordability barriers to SGLT2i prescription prior to discharge for patients admitted with HF.