Abstract Body (Do not enter title and authors here): Introduction:
Despite robust evidence demonstrating the cardiovascular and renal benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2-i), their prescription rates remain disproportionately low. In the context of acute heart failure (AHF), where therapeutic optimization is paramount for patient outcomes, understanding the hesitancy among healthcare providers to prescribe SGLT2-i is imperative.
Aims:
This study aims to identify reasons for the underutilization of SGLT2-i in AHF patients and elucidate healthcare providers’ perspectives on the barriers hindering the prescription of SGLT2-i. The goal is to inform strategies for the effective implementation of guideline-directed therapy (GDMT) in clinical practice.
Methods:
A survey comprising four questions was disseminated via the secure platform REDCap as part of a resident-led quality improvement initiative. The survey targeted a diverse array of healthcare providers involved in AHF patient care, including hospitalists, advanced practice practitioners, teaching attendings, residents, fellows, and inpatient pharmacists. Questions covered participant demographics, consideration of SGLT2-i initiation, and primary reasons influencing their decision not to prescribe these medications in AHF patients prior to hospital discharge.
Result:
Analysis of 97 responses from diverse healthcare providers revealed that while 86.6% considered initiating SGLT2-i, several barriers hindered prescription. Foremost among these was the concern over medication cost (29.9%), followed by the tendency to defer initiation to primary care providers (PCPs) (19.6%). Additionally, worries regarding acute kidney injury during hospitalization (10.3%), urinary tract infection/pyelonephritis (9.3%), and prioritization of other GDMT (9.3%) were recurrent themes influencing provider decision-making. Notably, the primary reasons varied across provider specialties and training levels.
Conclusion:
The study underscores a persistent reluctance among inpatient providers in a teaching hospital setting to prescribe SGLT2-i for AHF patients. Addressing identified barriers, particularly those related to medication cost and coordination of care with PCPs, is crucial for optimizing GDMT utilization and improving patient outcomes. By elucidating provider perspectives and delineating actionable insights, this research contributes to the ongoing dialogue surrounding the implementation of evidence-based practices in clinical cardiology.