Trisus Medication Compare powers ASHP presentation on SGLT2i use in acute heart failure

In the fellowship’s third collaborative research project, The Craneware Group’s Clinical Solutions team and the LIU Pharmacy Fellowship in Health Analytics and Artificial Intelligence are thrilled to share findings presented at the 2022 American Society of Health-System Pharmacists Midyear Clinical Meeting.

Addressing the gap in SGLT2i studies

 Recent studies on sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated clinical benefit such as reducing all-cause deaths and heart failure events in patients with acute HF exacerbation. The studies have small sample sizes, with little to no reporting on readmission rates and length of stay outcomes. Additionally, most studies evaluating SGLT2i use in acute heart failure focus on a single drug, rather than the whole class.

Is there a difference in 30-day all-cause readmission rates and length of stay in patients receiving SGLT2i and admitted for an acute heart failure exacerbation, compared to those not receiving SGLT2i therapy?

Our study aimed to be the first to assess the utilization of SGLT2i in acute heart failure patients and capture the largest real-world data study population. Previously, the most extensive study was a 2022 randomized controlled trial of 265 patients receiving empagliflozin (total population consisted of 530 patients) by Voors and colleagues, but length of stay and readmission were not reported.

Our findings

By leveraging Trisus Medication CompareTM (formerly CRCA P&T), we were able to generate a study population of 2,711 de-identified patients (SLGT2i, n=696; no SGLT2i, n=2015) admitted with an acute heart failure exacerbation between Jan. 1, 2019 and March 31, 2022.

Study groups did not differ at baseline for type of heart failure diagnosed (systolic, 55.0% vs. 55.6%; diastolic, 22.8% vs. 23.0%; combined systolic and diastolic, 23.7% vs 22.9%; other, 15.2% vs 13.8%). Patients receiving SGLT2i had a higher incidence of chronic ischemic heart disease, hypertension, and Type 2 diabetes mellitus (T2DM). Patients without SGLT2i treatment had a higher rate of chronic kidney disease (CKD).

Despite higher overall use of guideline-directed medical therapy in patients on SGLT2i, 30-day all-cause readmission rates were similar between those on SGLT2i and those not on SGLT2i therapy (22.0% vs. 24.1%, p=0.29). These findings remained consistent across subgroup analyses by HF type and CKD status.

However, subgroup analysis by T2DM status showed significantly lower readmission rates in those on receiving SGLT2i than those not receiving the therapy (22.2% vs. 26.9%, p=0.04). Average length of stay was longer in patients on SGLT2i (9.3 [10.0] vs. 8.7 [11.7] days, p<0.01). Safety outcomes assessed showed no difference in acute kidney injury, but the need for renal replacement therapy was higher in patients not on SGLT2i (1.9% vs. 8.4%, p<0.01).

Readmission rates and length of stay are meaningful clinical outcomes in patients admitted with acute heart failure exacerbation. Reporting on these outcomes can help in optimizing patient care while also serving as cost-saving opportunities. This project showcases the utility of The Craneware Group’s innovative and robust pharmacy analytics capabilities by providing insights into the real-world use of SGLT2i in acute heart failure exacerbations.

Previous fellowship research projects dealt with adoption of rituximab biosimilars and the use of reversal agents to manage severe bleeding in patients on direct-acting oral anticoagulants.