In-Hospital Initiation of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure With Reduced Ejection Fraction

• Published in: Journal of the American College of Cardiology 2021-11, Vol.78 (20), p.2004-2012
• Main Authors: Rao, Vishal N., Murray, Evan, Butler, Javed, Cooper, Lauren B., Cox, Zachary L., Fiuzat, Mona, Green, Jennifer B., Lindenfeld, JoAnn, McGuire, Darren K., Nassif, Michael E., O’Brien, Cara, Pagidipati, Neha, Sharma, Kavita, Vaduganathan, Muthiah, Vardeny, Orly, Fonarow, Gregg C., Mentz, Robert J., Greene, Stephen J.
• Format: Article
• Language: English
• Subjects: guideline-directed medical therapy; Heart Failure; Hospitalization; Humans; Hypoglycemic Agents - therapeutic use; in-hospital prescribing; medical therapy; Patient Discharge; Patient Readmission; Patient-Centered Care; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Risk; sodium-glucose cotransporter-2 inhibitors; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Stroke Volume; Ventricular Dysfunction, Left - drug therapy
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2021.08.064

Sodium-glucose cotransporter-2 inhibitor therapy is well suited for initiation during the heart failure hospitalization, owing to clinical benefits that accrue rapidly within days to weeks, a strong safety and tolerability profile, minimal to no effects on blood pressure, and no excess risk of adverse kidney events. There is no evidence to suggest that deferring initiation to the outpatient setting accomplishes anything beneficial. Instead, there is compelling evidence that deferring in-hospital initiation exposes patients to excess risk of early postdischarge clinical worsening and death. Lessons from other heart failure with reduced ejection fraction therapies highlight that deferring initiation of guideline-recommended medications to the U.S. outpatient setting carries a >75% chance they will not be initiated within the next year. Recognizing that 1 in 4 patients hospitalized for worsening heart failure die or are readmitted within 30 days, clinicians should embrace the in-hospital period as an optimal time to initiate sodium-glucose cotransporter-2 inhibitor therapy and treat this population with the urgency it deserves. [Display omitted] •Approximately 1 in 4 patients hospitalized for worsening HFrEF die or are re-admitted within 30 days after discharge.•The benefits of SGLT2i medication on the risks of death and hospitalization in patients with HFrEF accrue within days to weeks after initiation.•Safety, tolerability and early clinical benefit make SGLT2i therapy appropriate for in-hospital initiation in patients with HFrEF.