Recent data have shown significant benefit from SGLT2 inhibitors (SGLT2i) in patients with diabetes (DM) and cardiovascular disease (CVD) but experience with use in the acute care setting is limited and feasibility of initiating in the hospital is unclear. A multidisciplinary team of cardiology, endocrinology, and pharmacy developed a pilot to assess the feasibility of initiating SGLT2i in the hospital and subsequent transition of care. From 5/4/19 to 10/6/19, patients with DM on the cardiology service were identified and initiated on therapy with an SGLT2i if there were no contraindications. All patients were offered education via fact sheet, video, and/or focused consultation from the inpatient diabetes team. All prescriptions were either filled or verified as covered by insurance prior to discharge. An electronic communication was sent to notify the PCP and recommend basic metabolic labs be done at 2 weeks after initiation. 24 patients were eligible and 23 (96%) filled the prescription at discharge. 54.2% had CAD while 75% had CHF: 45.8% HFrEF and 29.2% HFpEF. The median GFR was 54 mL/min (44-64) and mean A1c was 8.1%. At 1 month, 71% remained on SGLT2i (n=17) and 63% completed recommended labs (n=15). 79% had outpatient follow up by 30 days (N=24) and 91% by 90 days (N=12). One patient died of respiratory failure within 30 days. 33% were readmitted within 90 days due to non-CHF cardiac illness (50%), respiratory problem (25%), lightheadedness (13%, n=1), or urinary tract infection (13%, n=1), and none for diabetes or CHF. There were no cases of metabolic acidosis or electrolyte disturbance. There was both a significant decrease in estimated GFR at 1 month (-6.95 mL/min, p= <0.01) and in systolic blood pressure of -4.62 mmHg (p=0.04). 6 patients had >30% reduced GFR and 1 advanced from CKD stage 4 to 5.
In conclusion, initiation of SGLT2i therapy in select patients with CVD and DM in the acute care setting appears to be feasible. Guidance is needed to ensure appropriate patient selection and medication adjustment in these patients.
N.E. Palermo: None. M. Goodberlet: None. G. Cromwell: None. C.M. Smith: None. L. Chang: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Other Relationship; Self; Applied Therapeutics, Fractyl Laboratories, Inc., Novo Nordisk Inc., Sanofi. A. Bilodeau: None. J. Plutzky: Consultant; Self; Amgen, AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. P.M. Szumita: None. O. Hulme: None. C. Cannon: None. M.E. McDonnell: None.