Abstract 14806: Rate of In-Hospital Initiation of SGLT2 Inhibitors Remains Low Despite Reduction in Rate of 30-Day Readmission From Heart Failure Exacerbation

Abstract

Introduction: Heart failure (HF) management guidelines recommend starting SGLT-2 inhibitors (SGLT2i) for symptomatic HF to reduce rates of HF hospitalization and cardiovascular mortality. However, in-hospital initiation of SGLT2i for titration has yet to be strongly recommended. In this study, we sought to evaluate the effect of in-hospital initiation of SGLT2i on the rate of 30-day HF-related readmission from an index admission for HF exacerbation at the University of Vermont Medical Center (UVMMC). Hypothesis: Patients who are admitted for an HF exacerbation who are discharged on SGLT2i from their index admission are less likely to be readmitted from an HF-related cause within 30 days of discharge compared to patients who are not started on an SGLT2i, though a minority of eligible patients will be started on SGLT2i during this time. Aims: The aims of this study are to 1) compare 30-day HF-related readmission rates between patients discharged on SGLT2i during their index admission, and patients not on SGLT2i, and 2) describe the proportion of patients not currently on SGLT2i who appear to be eligible. Methods: We conducted a chart review of 122 patients admitted to UVMMC from July to December 2022 with an HF exacerbation. We recorded patient and index admission descriptors, including ejection fraction, other GDMT (BB, RAASi, MRA), comorbidities, demographics, and admission duration. We then determined if 1) an HF-related readmission occurred within 30 days, 2) the patient was an acceptable candidate for SGLT2i, and 3) SGLT2i was present on discharge. Results: Among 122 patients admitted with an HF exacerbation at UVMMC, the 30-day HF-related readmission rate of patients discharged on SGLT2i was 3.7%, compared to 8.5% for patients not started on SGLT2i. Of these 122 patients, while 116 (95.1%) were acceptable candidates for SGLT2i, only 27 (23.3%) were discharged on SGLT2i, with 8 more (6.9%) eventually started on SGLT2i. Conclusions: Our review affirms guidelines that recommend starting SGLT2i in patients with symptomatic HF to reduce rates of HF hospitalization. Despite these guidelines, adoption rates remain low due to a variety of factors. Improving in-hospital SGLT2i initiation rates would benefit HF patients and the healthcare systems that support them.