The use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) has seen a notable rise among patients with type 2 diabetes (T2D) who were hospitalized with heart failure (HF). However, the uptake of these medications remains low, underscoring the need for better care coordination between hospital discharge and community care settings to enhance medication adherence, according to a recent study.
Transitional care plays a crucial role in supporting patients during a vulnerable period, allowing them to better manage their condition post-hospitalization. However, successful transitions require seamless coordination between hospital teams and community-based care providers, the authors of the study, published in Risk Management and Healthcare Policy, explained.
Medication adherence is critical for preventing heart failure readmissions, and pharmacists are increasingly recognized for their pivotal role in improving adherence through medication reconciliation and patient education. “Novel technologies could further expand access to pharmacy services, addressing the current gaps in transitional care for HF patients,” the study authors suggested.
Improving Adherence with Pharmacist-Led Interventions
In a randomized clinical trial, patients who underwent pharmacist-led interventions showed modest improvements in medication adherence compared to those receiving standard care. Patients in the intervention group had a higher proportion of days covered by heart failure medication, with a significant number reaching 80% or greater adherence, the study revealed.
Study Overview: SGLT2i Usage Trends
The study also examined the trends in population-level uptake of SGLT2i in patients with T2D hospitalized for heart failure. Researchers conducted a retrospective cohort analysis using data from Australian hospital admissions, pharmaceutical dispensings, medical services, and mortality records. The study focused on patients aged 18 and older with T2D and heart failure, discharged between January 2014 and June 2021.
The cohort included 18,932 patients hospitalized with heart failure during the study period, with a median age of 78 years. Approximately 63.7% of patients were on 10 or more unique medications in the 90 days prior to admission, and 10.7% were prescribed SGLT2i. The use of SGLT2i, initially low in 2014, steadily increased over the years, reaching a 13-fold rise by the end of the study.
Disparities in SGLT2i Prescribing Patterns
Between January 2020 and June 2021, out of 5,588 hospitalized individuals, 664 were dispensed SGLT2i within 90 days of discharge. The use of SGLT2i was notably higher among male patients and lower among older patients. Moreover, SGLT2i prescribing rates were lower in patients with complex health conditions, such as frailty, multiple comorbidities, and extended hospital stays.
During this period, 41.4% of patients received metformin, 27.8% were prescribed dipeptidyl peptidase 4 inhibitors, 22% received insulin, and 16.8% were given sulfonylureas. Among those dispensed SGLT2i, the likelihood of receiving additional heart failure medications was higher, including metformin (82.2%), beta-blockers (72.9%), loop diuretics (65.1%), and ACE inhibitors/angiotensin II receptor blockers (57.8%).
Enhancing Medication Initiation at Discharge
The study authors noted that a significant portion of patients who were dispensed SGLT2i post-hospitalization had already been on these medications prior to admission. They emphasized that improving care transition strategies, such as in-hospital medication reconciliation and discharge checklists, could help ensure optimal use of guideline-directed medical therapy (GDMT) following discharge.
Conclusion:
While the increased usage of SGLT2i in hospitalized diabetic heart failure patients is encouraging, the study underscores the need for improved care transitions and enhanced patient education. By optimizing medication reconciliation and integrating pharmacist-led interventions, healthcare providers can significantly improve medication adherence and outcomes for this vulnerable patient group.
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