Key result
In-hospital SGLT2i initiation prevents non-initiation, as deferring to outpatient care carries a >75% failure rate.
Why the study?
There is uncertainty about the optimal timing for initiation of SGLT2i therapy in patients hospitalized with HFrEF, specifically whether in-hospital initiation improves outcomes compared to deferring to outpatient settings.
Does in-hospital initiation of SGLT2 inhibitors prevent early post-discharge clinical worsening and death in patients hospitalized for HFrEF?
Does in-hospital initiation of SGLT2 inhibitors prevent early post-discharge clinical worsening and death in patients hospitalized for HFrEF?
In-hospital initiation of SGLT2 inhibitors for HFrEF is strongly advocated to prevent early post-discharge clinical worsening and death, given the high risk of non-initiation in the outpatient setting.
SGLT2i therapy is well suited for initiation during the HF hospitalization, owing to clinical benefits that accrue rapidly within days to weeks, a strong safety and tolerability profile, minimal to no effects on blood pressure, and no excess risk of adverse kidney events. There is no evidence to suggest that deferring initiation to the outpatient setting accomplishes anything beneficial. Instead, there is compelling evidence that deferring in-hospital initiation exposes patients to excess risk of early post-discharge clinical worsening and death. Lessons from other HFrEF therapies highlight that deferring initiation of guideline-recommended medications to the US outpatient setting carries a >75% chance they will not be initiated within the next year. Recognizing that 1 in 4 patients hospitalized for worsening HF die or are readmitted within 30 days, clinicians should embrace the in-hospital period as an optimal time to initiate SGLT2i therapy and treat this population with the urgency it deserves.
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Rao et al. (2021) conducted a review in Heart Failure With Reduced Ejection Fraction. In-hospital initiation of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) vs. Deferring initiation to the outpatient setting was evaluated. In-hospital initiation of SGLT2 inhibitors for HFrEF is recommended, as deferring guideline-directed therapies to the outpatient setting carries a >75% chance they will not be initiated within a year.
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