Abstract 15893: A Quality Improvement Project of Increasing Utilization of SGLT2i in Patients With Heart Failure Within a Veterans Affairs Health System Through an Interdisciplinary Approach in the Primary Care Setting

Abstract

Introduction: Given the astounding beneficial effects of SGLT2i in patients with heart failure, they continue to be underutilized especially in the outpatient setting. Our project looked at increasing empagliflozin usage in patients with heart failure, preserved and reduced ejection fraction, at James A Haley VA Hospital (JAHVA). Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team was created to identify ways to increase utilization of empagliflozin in patients with heart failure. We created an actionable database using ICD codes for heart failure to identify eligible heart failure patients who were not on SGLT2i categorized by local primary care clinics at the JAHVA. We split up the responsibilities between clinic pharmacists and primary care physicians to safely start patients on SGLT2i from February to April 2023. Primary care physicians focused on patients scheduled for clinic during this period while pharmacists were responsible for patients not scheduled for clinic. Results: Our initial data showed only 19% of the 3,352 patients were on SGLT2i at JAHVA. From February to April 2023, we started 224 patients on empagliflozin with heart failure (preserved and reduced ejection fraction). We increased utilization by 13% in three months from 19% to 32% at JAHVA. Primary care physicians accounted for 46% of drug initiation while pharmacists accounted for 20% of new prescriptions. Cardiology providers prescribed 27% of all SGLT2i with 7% started by endocrinology or nephrology. Some of the characteristics of our sample included patients with an average age of 70 years old, 35% without diabetes, 50% with preserved heart failure. Conclusion: Our multi-disciplinary team approach involving pharmacists increased the utilization of SGLT2i in patients with heart failure through an actionable dashboard. Next steps for this project include improving the database to include other GDMT to further optimize medications.