Inpatient initiation of sodium-glucose cotransporter-2 inhibitors: the prescribing learning curve.
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All Authors
Gross, C.
Hammad, HF.
Slater, TA.
Straw, S.
Anderton, T.
Coyle, C.
McGinlay, M.
Gierula, J.
Gatenby, VK.
Nayar, V.
LTHT Author
Gross, Charlotte
Gatenby, Kate
Gatenby, Kate
LTHT Department
Cardiology
Cardio-Respiratory
Cardio-Respiratory
Non Medic
Publication Date
2024
Item Type
Journal Article
Language
Subject
Subject Headings
Abstract
We aimed to describe the safety and tolerability of initiation of sodium-glucose cotransporter 2 inhibitors (SGLT2i) during hospitalisation with heart failure, and the frequency of, and reasons for, subsequent discontinuation. In total, 934 patients who were not already prescribed a SGLT2i were hospitalised with heart failure, 77 (8%) were initiated on a SGLT2i a median of five (3-8.5) days after admission and two (0.5-5) days prior to discharge. During a median follow-up of 182 (124-250) days, SGLT2i were discontinued for 10 (13%) patients, most frequently due to deteriorating renal function. We observed reductions in body weight (mean difference 2.0 +/- 0.48 kg, p<0.001), systolic blood pressure (mean difference 9.5 +/- 1.9 kg, p<0.001) and small, non-significant reductions in estimated glomerular filtration rate (eGFR mean difference 2.0 +/- 1.5 ml/min/1.73 m2, p=0.19) prior to initiation, with further modest reductions in weight (mean difference 1.2 +/- 0.4 kg, p=0.006) but not systolic blood pressure (2.4 +/- 1.5 mmHg, p=0.13) or eGFR following initiation of SGLT2i. At discharge the proportion prescribed a beta blocker (44% to 92%), angiotensin-receptor/neprilysin inhibitor (6% to 44%) and mineralocorticoid-receptor antagonist (35% to 85%) had increased. In conclusion, inpatient initiation of SGLT2i was safe and well tolerated in a real-world cohort of patients hospitalised with worsening HF. We observed a 13% frequency of discontinuation or serious side effects.
Journal
British Journal of Cardiology