Inpatient SGLT2i Initiation and Its Impact on HFpEF Prescription Rates and Clinical Outcomes

Introduction: Although sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular death and heart failure (HF) hospitalizations in heart failure with preserved ejection fraction (HFpEF), their use as part of guideline-directed medical therapy (GDMT) remains suboptimal. This study evaluated the impact of inpatient SGLT2i initiation on outpatient prescription rates and clinical outcomes in patients with HFpEF.


Methods: This single-center, retrospective study included adults (≥18 years) admitted between September 2021 and August 2024, with HF and LVEF ≥50%, and discharged from internal medicine or cardiology services were included. Exclusion criteria were prior SGLT2i use, end-stage kidney disease, type 1 diabetes, ketoacidosis, or pregnancy. Patients with inpatient SGLT2i initiation versus no initiation were compared. The primary outcome was the incidence of an active SGLT2i prescription at 30-days post-discharge. Secondary outcomes included HF readmissions, all-cause mortality, cardiac mortality, and discontinuation within 90 days.


Results: A total of 52 patients were included: 25 with inpatient SGLT2i initiation and 27 without. The two groups had no statistically significant differences in baseline characteristics. The SGLT2i group had significantly higher prescription rates at 30 days (88% vs. 15%, p < 0.001) and 90 days (88% vs. 19%, p < 0.001). At discharge, mineralocorticoid receptor antagonists (MRAs) (64% vs. 33%, p = 0.027) and loop diuretics (88% vs. 59%, p = 0.029) were more frequently prescribed in the SGLT2i group. No statistically significant differences were found in clinical outcomes, including 30- and 90-day HF hospitalizations, all-cause readmissions, cardiovascular mortality, or all-cause mortality. Insurance coverage inquiries were completed prior to discharge more frequently in the SGLT2i group (84% vs. 30%, p < 0.001).


Conclusions: Inpatient SGLT2i initiation was associated with significantly higher prescription rates at 30- and 90-days post-discharge. No significant differences in readmissions or mortality were observed. Hospitalization offers a key opportunity to optimize GDMT.