Sarah Bermudez, PharmD: SGLT2 Inhibitors Underutilized in Heart Failure Care

New findings on the prescribing rates of sodium-glucose cotransporter 2 inhibitors found they are underutilized in patients with heart failure with or without type 2 diabetes (T2D), despite guideline recommendations.

From a cohort of patients in a single-center with a diagnosis of heart failure and visit between August 2020 and August 2021, a total of 2,905 were identified and 1,101 were randomly reviewed.

Data show SGLT2 inhibitors were prescribed in 6.5% of patients overall, 14.7% of patients with T2D, and 0.4% of patients without T2D. Investigators noted the predictors included diabetes diagnosis, heart failure with reduced ejection fraction (HFrEF), having a cardiology provider, being seen by a pharmacist with prescriptive authority, and enrolled in a patient assistance program.

The late-breaking findings were presented at the American Diabetes Association (ADA) 2022 Scientific Sessions.

In an interview with HCPLive, presenting investigator Sarah Bermudez, PharmD, University of New Mexico, discussed the findings on the prescribing patterns and why they set out to determine what factors may predict who is receiving these agents.

“We wanted to add to the literature by looking at patients that only had that heart failure aspect,” Bermudez said. “On that, the more secondary objective was to really identify the predictors of these prescribing rates.”

Bermudez went on to discuss the above findings on the predictors, highlighting HFrEF and T2D as main predictors due to the previous approvals of dapagliflozin and empagliflozin. She noted that it wa

“Some other interesting things that we found was when patients were on three drug guideline directed medical therapy for heart failure, they were also more likely to be prescribed an SGLT2i to help encompass that 4-drug guideline directed medical therapy,” Bermudez said. “And then on top of that, we found that patients that were part of our patient assistance program, were also more likely to have these agents because they were on our formulary.

Although demographics were expected to be a predicting factor of prescribing patterns, the investigators observed that demographics including age, gender, and coverage were not predicting factors for patients receiving the agents.

In order to determine the different predictors of SGLT2i utilization, Bermudez noted the trial will need to be extended to determine the reason behind clinical inertia. Meanwhile, she highlighted the ACC/AHA/HFSA updated guidelines encompassing SGLT2i as a class 1a recommendation which may help transition clinicians to using the agents.

“With this trial, we're really hoping to see in the future how long it'll take for them to start becoming utilized, based on the updated guidelines and then the updated indications,” Bermudez said. “We are looking forward to seeing the new trials coming out in HFpEF to see if that'll have an influence in this trial.”

The study, “Prescribing Patterns of Sodium–Glucose Cotransporter 2 Inhibitors in Patients with Heart Failure With or Without Type 2 Diabetes,” was presented at ADA 2022.