SGLT2i Use Increases, But Uptake Remains Low for Patients With Diabetes and Heart Failure
Pharmacist-led interventions improve medication adherence compared with the usual care for patients with heart failure and type 2 diabetes.
Sodium-glucose cotransporter 2 inhibitor (SGLT2i) usage increased for patients with type 2 diabetes (T2D) who were hospitalized with heart failure. However, uptake is low, indicating that better transition from hospital to community care is necessary for medication adherence.1
Transitional care for patients with heart failure occurs during a vulnerable period in the patients’ lives and can improve self-management. However, coordination between the health system setting and community setting is necessary for a successful transition, according to authors of a study published in Risk Management and Healthcare Policy.2
“Because medication nonadherence is a risk factor for HF readmission and because of the unique ability to provide education about medication reconciliation, the impact of the pharmacist’s role in medication adherence has been emphasized,” the study authors stated.2 “Novel technologies to expand access to pharmacy services could improve the current limitations of transitional care in HF patients.”
In a randomized clinical trial, patients with congestive heart failure had modest improvements in medication adherence when undergoing a pharmacist-led intervention compared with the usual care. Investigators found that patients in the intervention group had a higher proportion of days covered for heart failure medication and a greater proportion of patients with a proportion of days covered of 80% or greater compared to the usual care group, according to the study authors.3
Investigators aimed to determine the trends in population-level uptake of SGLT2i for patients who have T2D and were hospitalized with heart failure. They conducted a retrospective cohort study using data from hospital admission, pharmaceutical dispensing, medical service, and mortality in Australia. Patients included were 18 years or older with T2D with a primary or secondary diagnosis of heart failure and discharged between January 1, 2014, and June 30, 2021.1
There were 18,932 patients with T2D that were hospitalized with HF between 2014 and 2021, with 56.9% being male and a median age of 78 years. Approximately 62% had a secondary diagnosis, and approximately 63.7% of patients were utilizing 10 or more unique medications in the 90 days prior to admission; 10.7% were SGLT2i. Usage of SGLT2i was generally low in 2014 but gradually increased over time, with a 13-fold increase across the study period, according to the investigators.1
From January 2020 to June 2021, there were 5588 individuals hospitalized, with 664 being dispensed SGLT2i within 90 days of discharge. Usage was higher in males and was lower with increasing age, according to the study authors. SGLT2i usage was lower for patients with more complex health issues, such as increased frailty, higher comorbidities, and length of hospital stay. In the same time period, 41.4% of patients received metformin, 27.8% received dipeptidyl peptidase 4, 22% received insulin, and 16.8% received sulfonylureas. For patients dispensed SGLT2i, the prevalence of dispensing of other medications was higher, including 82.2% being metformin, 72.9% being beta-blockers, 65.1% being loop diuretics, or 57.8% being angiotensin-converting enzyme inhibitors /angiotensin II receptor blockers.1
“We observed a minority of patients initiating on SGLT2i post hospitalisation, as most patients dispensed SGLT2i were already using this medicine class prior to hospitalisation,” the study authors said.1 “Care transition strategies such as in-hospital medicine reconciliation and discharge checklists may help ensure optimal use of GDMT [guideline-directed medical therapy].”
READ MORE: Diabetes Resource Center
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