Multidisciplinary Approach To Incorporating Sodium-glucose Co-transporter 2 Inhibitors In Ambulatory Heart Failure Patients

Abstract

<h3>Introduction</h3> : In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) gained an indication in heart failure (HF) with reduced ejection fraction. With reduced cardiovascular mortality and HF hospitalizations, SGLT2i are now recommended and incorporated into the 2021 Update of the 2017 ACC Expert Consensus Decision Pathway for Optimization of HF Treatment. <h3>Hypothesis</h3> Multidisciplinary screening of patients in the ambulatory setting can identify qualified patients and facilitate SGLT2i initiation. <h3>Methods</h3> A SGLT2i initiation pilot program was started at the REX HF Clinic. During the pilot, a Clinical Pharmacist (CP) screened candidates based on select baseline demographics that included primary indications and contraindications to SGLT2i. It was decided that preference would be given to titration of traditional guideline-directed medical therapy (GDMT) over SGLT2i initiation. The CP screened all patients, identified those that qualified, and shared findings with the HF providers. Recommendations were made with consideration of SGLT2i cost and insurance-preferred agent. The HF provider and patient discussed medication changes as part of the clinic visit. When a SGLT2i was prescribed, the CP provided education to the patient, facilitated affordability by providing manufacturer coupon cards or assistance program applications, and monitored patient response and safety. <h3>Results</h3> : Two hundred forty-one unique patients were screened from October 2020 to April 2021, of which 112 patients (46.4%) qualified for SGLT2i (see TABLE 1). Sixty-four of the 112 patients had titration of other GDMT (57.1%). Of the remaining 48 patients, 12 were started on SGLT2i, while 7 had a contraindication. No medication changes were made in 15 patients, mostly due to patient preference or cost concerns.