Impact of pharmacist-led interventions on prescribing of SGLT2 inhibitors in hospitalized patients with heart failure

PURPOSE: The purpose of this study was to evaluate the impact of pharmacist-led interventions on sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing in hospitalized patients with heart failure with reduced ejection fraction (HFrEF). METHODS: A quality improvement study was conducted at an academic medical center with 2 phases: a retrospective medication-use evaluation (phase I) and a prospective intervention period (phase II). Phase I assessed eligibility for SGLT2i initiation in hospitalized patients with HFrEF without active study intervention. In phase II, interdisciplinary education on the benefits and place in therapy of SGLT2i was provided. A pharmacist routinely reviewed electronic health records to identify patients eligible for SGLT2i and recommended therapy initiation. The primary endpoint of the study was the percentage of eligible patients on an SGLT2i before and after implementation of pharmacist intervention. Secondary endpoints included 30-day all-cause and heart failure readmission rates, the quantity and acceptance rate of pharmacist interventions, and the incidence of adverse outcomes. RESULTS: Among 150 patients in phase I and 133 patients in phase II, 123 and 94 were eligible for SGLT2i therapy, respectively. The overall frequency of inpatient SGLT2i prescribing significantly increased from phase I to phase II (38.2% vs 68.1%, respectively; P < 0.001). Continuation of outpatient SGLT2i therapy during hospitalization also improved after implementation of pharmacist intervention (from 16.3% to 36.2%; P = 0.001). There were no differences in readmission rates or the incidence of adverse events. The acceptance rate for pharmacist interventions was 50%. CONCLUSION: Increased prescribing of SGLT2i therapy in hospitalized patients with heart failure was observed following pharmacist-led education and prospective reviews with feedback.