Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure

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. 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.

Duke Scholars

Author Judson Blount Williams Jr. Surgery, Cardiovascular and Thoracic Surgery