Utilization rate and predictors of sodium-glucose cotransporter 2 inhibitor use in patients with heart failure: A continuing review

Abstract Purpose Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are recommended for all patients with heart failure (HF) irrespective of type 2 diabetes (T2D) due to their immense cardiovascular benefit. We previously conducted a study characterizing SGLT2i prescribing rates that demonstrated a sparse utilization rate of 6.5%. The objective of this study was to evaluate changes in prescribing patterns for SGLT2is from 2021 to 2023 following publication of updated HF guidelines and identify predictors of SGLT2i use. Methods This retrospective, single-center, descriptive chart review included individuals 18 years of age or older with a documented diagnosis of HF and a clinic encounter in our primary care, cardiology, HF, nephrology, or endocrinology clinic from December 2021 through November 2023. Patient characteristics and changes in prescribing patterns were reported with descriptive statistics. Potential predictors of SGLT2i prescribing were identified using forward conditional logistic regression analyses. Results A total of 395 patients were included: 148 with HF with reduced ejection fraction (HFrEF), 63 with HF with mildly reduced ejection fraction, and 184 with HF with preserved ejection fraction. With respect to baseline characteristics, the mean age was 68 years, 44% of patients were female, 54% were Hispanic, and 42% had T2D. SGLT2is were prescribed in 28.1% of patients overall, including in 45.9% of patients with T2D and 12.4% of patients without T2D. Predictors of SGLT2i prescribing included T2D (odds ratio OR, 4.29; 95% confidence interval CI, 2.42-7.6), HFrEF (OR, 2.24; 95% CI, 1.27-3.93), a visit with a pharmacist clinician (OR, 4.9; 95% CI, 1.91-12.57), and a higher number of clinic visits (OR, 1.12; 95% CI, 1.07-1.18). Conclusion SGLT2i utilization has improved since 2021 at our institution; however, these agents continue to be underprescribed in patients with HF despite current guideline recommendations.