Racial Patterns in SGLT2 Inhibitor Prescribing by Care Signature pathway Use in HFrEF Hospitalizations

Background: Guideline-directed medical therapy improves outcomes for patients with heart failure with reduced ejection fraction, yet racial disparities in receipt of evidence based therapies persist. This study examined whether use of an EHR-embedded Care Signature Pathway (CSP) was associated with racial differences in discharge prescribing of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Methods: A retrospective cohort study of HFrEF hospitalizations was conducted across seven hospitals from September 2021 through September 2023. Logistic regression included race, CSP use, and a race × CSP interaction, adjusting for age, comorbidity burden, noninvasive ventilation, insurance status, and ejection fraction. Results: Among 2,052 hospitalizations, CSP was used in 17.6%, with similar use among Black and non-Black patients. SGLT2 inhibitor prescribing was higher among Black than non-Black patients (56.1% vs 48.9%; p=0.003). Among Black patients, prescribing was higher with CSP use than without it (66.3% vs 54.1%; p=0.023), whereas rates were similar among nonBlack patients (50.0% vs 48.6%; p=0.69). The race × CSP interaction was directionally consistent but not statistically significant (OR 1.64; 95% CI 0.96–2.82; p=0.071). Conclusions: CSP use may be associated with higher SGLT2 prescribing among Black patients. These hypothesis-generating findings warrant investigation.