Abstract 15007: Time to SGLT2i Initiation in Patients With Heart Failure

Abstract

Introduction: SGLT2i, initially introduced as antidiabetic agents, have shown cardiovascular benefits for heart failure (HF) patients, irrespective of their diabetes status. Given the growing evidence from post-hoc analyses of landmark trials advocating for early initiation, this study aims to investigate the temporal trends in the timing of SGLT2i initiation after HF hospitalization. Methods: A cross-sectional study was conducted using administrative health data from Ontario, Canada. Our cohort included patients aged ≥65 years who filled an SGLT2i prescription after their HF hospitalization in Ontario, Canada between 4/2016-3/2021. We computed the median number of days to the first SGLT2i prescription after the HF discharge date, exclusively for patients who started SGLT2i. Patients were further stratified based on their diabetes status. Results: We identified 64,183 HF patients, of which 5,257 filled an SGLT2i prescription after discharge (mean age was 82.49; 46.9% men; 49.6% had diabetes). The number of patients starting an SGLT2i increased from 889 (16.9%) in 2016/17 to 1,206 (22.9%) by 2020/21. The median time from discharge following the index HF admission to first dispensation of an SGLT2i prescription decreased 7-fold over this period, from 1,082 days to 156 days (Figure 1). In 2016/17, patients with diabetes started an SGLT2i at a median of 930 days, and patients without diabetes at 1,640 days. However, by 2020/21, the median initiation times were closer at 143 and 189 days, respectively. Conclusions: Our findings demonstrate a substantial reduction in the time to SGLT2i initiation for patients after HF admission, suggesting increased clinician recognition of their cardiovascular benefits. However, initiation remains delayed, especially for patients without diabetes. To optimize patient outcomes, it is crucial to encourage early initiation of SGLT2i therapy in hospitalized HF patients and address potential barriers to SGLT2i initiation.