Increasing Sodium‐Glucose Cotransporter‐2 (Sglt2) Inhibitor Prescriptions for Inpatient Heart Failure Care

Document Type

Conference Proceeding

Publication Date

3-30-2026

Publication Title

Br J Hosp Med

Keywords

sodium glucose cotransporter 2, sodium glucose cotransporter 2 inhibitor, cardiovascular mortality, conference abstract, congestive heart failure, controlled study, drug therapy, electronic medical record, female, heart failure, hospital admission, hospitalization, human, major clinical study, male, medical education, multidisciplinary team, pharmacist, prescription, retrospective study, therapy, workflow

Abstract

Background: It is well‐known that goal‐directed medical therapy (GDMT) for congestive heart failure (CHF) improves mortality. One component of GDMT is sodium‐glucose cotransporter 2 inhibitors (SGLT2‐i), which have been shown to decrease cardiovascular death and heart failure hospitalizations by 33%. A three‐month retrospective review of all Medical Teaching Service (MTS) teams at our institution revealed a noticeable gap in the rate at which this medication was prescribed to patients with CHF who met the criteria during hospital admissions. We aimed to increase the rate this medication group was prescribed to qualifying patients on MTS teams. Methods: Baseline data for the percentage of patients admitted with CHF, whether in exacerbation or not, who were prescribed SGLT2‐i was collected from December 2023 through April 2024. The primary outcome measure was the percentage of patients with CHF who were prescribed SGLT2‐i at discharge, continued their already prescribed SGLT2‐i at discharge, or documented intention to discuss or start medication in the outpatient setting. Bi‐weekly EMR‐generated reports were reviewed to track this outcome, and the data was plotted on a run chart to allow for real‐time analysis. Our goal was to increase the median percentage of prescription rate of SGLT2‐i from a baseline of 37% to 55% by December 2024, with an overall upward trend on the run chart. For our first PDSA cycle, we first focused on education with residents on MTS teams through monthly lectures detailing the importance and contraindications of SGLT2‐i in this patient population. Teams were also given info sheets to refer to during their daily workflow within the team rooms. Additionally, residents were provided with a smart phrase template to utilize in documentation that detailed all the GDMT needed for CHF patients, including SGLT2‐i. The smart phrase was later tailored in real‐time based on resident feedback. Results: Prior to our intervention, 37% of providers were prescribing SGLT2 inhibitors for qualifying patients admitted with CHF to MTS teams. Following the intervention, the median percentage of providers prescribing SGLT2 inhibitors increased by 18%, ultimately reaching our goal of 55%. Although there were fluctuations in the prescribing rates across the months, the overall trend demonstrated in our run chart was upward and showed a consistent improvement in the median percentage of providers post‐intervention. Conclusions: Our QI initiative demonstrated a consistent improvement in prescribing SGLT2 inhibitors for patients admitted with CHF on MTS teams. To sustain these improvements, ongoing training for current and future residents will be essential to reinforce the established guidelines, ensuring consistent adherence among all residents. Other upcoming directions also include introducing process measures, such as tracking use of the smart phrase by residents, as well as the implementation of a multidisciplinary team approach with inclusion of a cardiac pharmacist.

Volume

21

First Page

S822

Last Page

S823

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