Prescription patterns of <scp>SGLT2</scp> inhibitors in patients admitted to a tertiary health service with heart failure with reduced ejection fraction: an opportunity to improve

BACKGROUND: Sodium-glucose co-transporter 2 inhibitors (SGLT2is) improve symptoms, reduce hospitalisations and increase survival in patients with heart failure with reduced ejection fraction (HFrEF). This study evaluated SGLT2i prescribing compliance in hospitalised patients with HFrEF at an Australian tertiary hospital. METHODS: A 10-month retrospective review of patients treated for HFrEF (left ventricular ejection fraction ≤40%) was conducted. Patients were grouped as already on SGLT2i pre-admission, initiated during admission, or not prescribed. Demographics, renal function, prescribing barriers, and post-discharge outcomes were analysed. RESULTS: Of 142 patients, 27% were already taking an SGLT2i; of the rest, 46% were initiated during admission and 54% were not prescribed. Initiation rates were higher under cardiology (67% vs. 36%, P = 0.012). Non-prescription was associated with older age, 80 versus 69 years for already prescribed (P=0.001) and 72 years for initiated during admission (P=0.007), and lower creatinine clearance, 48 mL/min versus 64 mL/min for already prescribed (P 0.049) and 61 mL/min for initiated during admission (P=0.047). Only one patient had an absolute contraindication; relative contraindications, mainly acute kidney injury (65%) and acute illness (35%), were documented in 25% of non-prescribed cases. Just 9% of patients without inpatient initiation had discharge recommendations for community commencement. Thirty-day readmission and mortality rates were numerically lower in patients prescribed SGLT2is, though differences were not statistically significant. CONCLUSION: SGLT2is remain under-prescribed in hospitalised patients with HFrEF, with advanced age and renal impairment influencing non-prescription despite limited true contraindications. Implementing standardised prescribing protocols, reassessing relative contraindications prior to discharge and improving communication with primary care may enhance uptake of this guideline-recommended therapy.