Will a Rising SGLT2 Inhibitor Tide Lift All GDMT Boats

Purpose The addition of SGLT2 inhibitors (SGLT2i) to goal directed medical therapy (GDMT) in HFrEF patients has been shown to reduce morbidity and mortality, and there are potential but unstudied benefits in LVAD patients. A provider education program and SGLT2i initiation protocol sought to optimize SGLT2i use in an outpatient LVAD clinic. The purpose of this evaluation was to determine the impact of this initiative on the prescribing of other GDMT. Methods This was a retrospective, cross-sectional cohort study in a single outpatient LVAD clinic. The primary outcome was the difference in utilization of GDMT prior to (May/June 2019) and after (May/June 2020) protocol development and provider education on initiation of SGLT2i. The protocol and educational initiative placed no systematic emphasis on improving prescribing of HF or antidiabetic agents aside from SGLT2i. Chi-square and t-tests were used to compare categorical and continuous variables, respectively. Results A total of 272 patient encounters were assessed. Between the two cohorts, there were no differences in patient demographics, LVAD support characteristics, clinical status, or provider type (Table 1). The rate of SGLT2i utilization increased significantly as a result of the education and protocol (22% vs 0%, p Conclusion In addition to the anticipated increase in SGLT2i prescribing, there were significant improvements in adherence to GDMT in an outpatient LVAD population following a focused SGLT2i education effort and initiation protocol. There were no differences in patient or clinical characteristics which would contribute to the improvement in therapy optimization. An enhanced focus on the role of a single therapeutic class can result in an improvement in prescribing patterns for all GDMT in LVAD patients.