Key result
Inpatient SGLT2i initiation in HFpEF linked to ~6-fold higher active prescription rates post-discharge.
Why the study?
Although SGLT2 inhibitors reduce cardiovascular death and heart failure hospitalizations in HFpEF, their use as part of guideline-directed medical therapy remains suboptimal.
Does inpatient SGLT2i initiation improve active SGLT2i prescription rates at 30-days post-discharge in adults hospitalized with HFpEF?
Does inpatient SGLT2i initiation improve active SGLT2i prescription rates at 30-days post-discharge in adults hospitalized with HFpEF?
Inpatient initiation of SGLT2 inhibitors in patients with HFpEF significantly increases the likelihood of maintaining the therapy at 30 and 90 days post-discharge.
Supports inpatient SGLT2i initiation in hospitalized HFpEF; extends evidence to acute care uptake but remains hypothesis-generating pending RCTs.
Introduction: Although sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular death and heart failure (HF) hospitalizations in heart failure with preserved ejection fraction (HFpEF), their use as part of guideline-directed medical therapy (GDMT) remains suboptimal. This study evaluated the impact of inpatient SGLT2i initiation on outpatient prescription rates and clinical outcomes in patients with HFpEF. Methods: This single-center, retrospective study included adults (≥18 years) admitted between September 2021 and August 2024, with HF and LVEF ≥50%, and discharged from internal medicine or cardiology services were included. Exclusion criteria were prior SGLT2i use, end-stage kidney disease, type 1 diabetes, ketoacidosis, or pregnancy. Patients with inpatient SGLT2i initiation versus no initiation were compared. The primary outcome was the incidence of an active SGLT2i prescription at 30-days post-discharge. Secondary outcomes included HF readmissions, all-cause mortality, cardiac mortality, and discontinuation within 90 days. Results: A total of 52 patients were included: 25 with inpatient SGLT2i initiation and 27 without. The two groups had no statistically significant differences in baseline characteristics. The SGLT2i group had significantly higher prescription rates at 30 days (88% vs. 15%, p < 0.001) and 90 days (88% vs. 19%, p < 0.001). At discharge, mineralocorticoid receptor antagonists (MRAs) (64% vs. 33%, p = 0.027) and loop diuretics (88% vs. 59%, p = 0.029) were more frequently prescribed in the SGLT2i group. No statistically significant differences were found in clinical outcomes, including 30- and 90-day HF hospitalizations, all-cause readmissions, cardiovascular mortality, or all-cause mortality. Insurance coverage inquiries were completed prior to discharge more frequently in the SGLT2i group (84% vs. 30%, p < 0.001). Conclusions: Inpatient SGLT2i initiation was associated with significantly higher prescription rates at 30- and 90-days post-discharge. No significant differences in readmissions or mortality were observed. Hospitalization offers a key opportunity to optimize GDMT.
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Li et al. (2026) studied this question. Inpatient SGLT2i initiation in HFpEF patients significantly increased active prescription rates at 30 days (88% vs. 15%, p<0.001) and 90 days (88% vs. 19%) post-discharge.
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