Abstract 14215: Mortality and Readmission Among Medicare Beneficiaries Hospitalized for Heart Failure Who Are Treatment Candidates for SGLT-2 Inhibitors

Abstract

Background: SGLT2i form the latest pillar in the management of HFrEF and appear effective across a range of patient profiles. There is increasing interest around initiation of SGLT2i during hospitalization, yet little is known about the putative benefits of this implementation strategy. Methods: We evaluated Medicare beneficiaries with HFrEF (≤40%) hospitalized at 228 sites in the GWTG-HF Registry in 2016 who had linked claims data for ≥1 year post-discharge. We identified those eligible for a SGLT2i under the FDA label for dapagliflozin (excluding eGFR<30 mL/min per 1.73 m 2 , dialysis, or type 1 diabetes). We evaluated 1-year outcomes overall and among key subgroups (age≥75y, sex, race, hospital region, eGFR, diabetes status, triple therapy). Results: Among 7,767 patients hospitalized for HFrEF, 6,218 (80%) would be SGLT2i candidates (mean age 79±8y, 38% women, 12% Black). Among eligible candidates, discharge use of β-blockers, ACEi/ARB, MRA, ARNI, and triple therapy (ACEi/ARB/ARNI+β-blocker+MRA) was in 86%, 65%, 30%, 3%, and 21%, respectively. Treatment candidates faced a 1-year incidence [95% CI] of mortality and HF readmission of 38% [36-39%] and 32% [31-33%], respectively, and each exceeded 25% across all key subgroups. Among 1,301 beneficiaries eligible for already on triple therapy, 1-year incidence of mortality was 26% [24-28%] and 1-year HF readmission was 30% [27-32%]. Conclusions: Medicare beneficiaries eligible for SGLT2i after HF hospitalization, including those well-treated with other disease-modifying therapies, face high risks of mortality and HF readmission by 1 year. Whether these heightened risks can be modified with implementation of SGLT2i at time of a worsening HF event is the subject of ongoing clinical trials.