Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure
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Heart Failure (W Tang, Section Editor)
Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure Kathleen D. Faulkenberg, PharmD, BCPS1 J. Bradley Williams, PharmD, BCPS1 Diana M. Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES2 Lucianne M. West, PharmD, BCCP1,* Address *,1 Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave, Hb-105, Cleveland, OH, 44195, USA Email: [email protected] 2 Department of Pharmacy, Cleveland Clinic, 10685 Carnegie Ave, X-20, Cleveland, OH, 44195, USA
Published online: 22 September 2020 * Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Heart Failure Keywords Heart failure, I Diabetes I SGLT2 inhibitor I Medication optimization I Pharmacotherapy
Abstract Purpose of review Appropriate selection of anti-hyperglycemic agents that are both safe and effective is critical to improve outcomes for individuals with heart failure. Although emerging evidence supports the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors for heart failure patients with or without diabetes, barriers to prescribing these agents still exist. This comprehensive review will focus on evidence supporting SGLT2 inhibitors for patients with heart failure and practical considerations when prescribing these agents in clinical practice. Recent findings Based on evidence of improved cardiovascular outcomes for patients initiated on SGLT2 inhibitors, guidelines recommend the use of these agents for people with type 2 diabetes mellitus and cardiovascular disease, or at high cardiovascular risk, to reduce cardiovascular events and lower risk of heart failure hospitalization, independent of hemoglobin A1c. Additional trials are either underway or completed assessing SGLT2 inhibitors for people with heart failure without diabetes mellitus. Despite the positive evidence and guideline recommendations, SGLT2 inhibitors remain under-utilized in clinical practice. Summary In addition to cost and insurance requirements, concern regarding concomitant complex medication regimens and potential adverse events may impede prescribing.
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Curr Treat Options Cardio Med (2020) 22: 36
Innovative models, such as pharmacist-led cardio-endocrinology and heart failure medication optimization clinics, can be implemented to ensure safe prescribing and monitoring of SGLT2 inhibitors.
Introduction Approximately 6.2 million adults in the USA have heart failure, with the prevalence projected to increase nearly 50% by 2030 [1]. The rate of heart failure hospitalizations remains high, which has not improved despite contemporary therapies aimed at reducing disease morbidity and mortality in patients with heart failure and a reduced ejection fraction (HFrEF). The incidence of heart failure is approximately two times higher in people with diabetes mellitus, and approximately 40% of people hospitalized for heart failure have diabetes [2–4]. Diabetes mellitus alone qualifies for the most recent ACC/AHA diagnostic criteria for stage A hear
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