# Heart Failure Treatment in Underserved Populations: A Comprehensive Analysis of Sacubitril/Valsartan and Sodium-Glucose Transporter 2 Inhibitor (SGLT2i) Prescription Trends at a Safety Net Hospital

## TL;DR

This study examines how heart failure medications are prescribed at a safety net hospital, focusing on dosing patterns and prescriber roles.

## Contribution

The study provides insights into real-world prescribing trends of sacubitril/valsartan and SGLT2i in an underserved population.

## Key findings

- Nurse practitioners and other ancillary staff prescribed most sacubitril/valsartan doses, while cardiologists prescribed only 23.3%.
- Internal/family medicine physicians prescribed over half of SGLT2i medications, with cardiologists accounting for only 10%.
- Dosing patterns for both medications showed a wide range, indicating their adaptability in treating diverse patient needs.

## Abstract

Background

Sacubitril/valsartan and sodium-glucose transporter 2 inhibitors (SGLT2is) are emerging classes of medications that have become key components of guideline-directed medical therapy for patients with heart failure (HF) with reduced ejection fraction and New York Heart Association class II, III, or IV symptoms. Both sacubitril/valsartan and SGLT2is have demonstrated the ability to improve morbidity and mortality in HF patients. This analysis evaluates current prescribing trends of sacubitril/valsartan and SGLT2is in a safety net hospital setting.

Methods

In this retrospective study, a chart review was conducted to identify sacubitril/valsartan use, categorized by drug dose and prescriber specialty, at University Health Truman Medical Centers in Kansas City, Missouri, USA, from October 1, 2021, to October 31, 2022. A second chart review similarly identified SGLT2i usage, also categorized by drug dose and prescriber specialty, within the same time frame and healthcare system.

Results

Of the 769 patients prescribed sacubitril/valsartan, 497 (64.6%) were prescribed the 24 mg/26 mg dose, 193 patients (25.1%) received the 49 mg/51 mg dose, and 79 patients (10.3%) were on the 97 mg/103 mg dose. Cardiologists accounted for only 23.3% of sacubitril/valsartan prescriptions, while ancillary staff, including nurse practitioners, physician assistants, and pharmacists, accounted for the majority (49.8%) of prescriptions. Regarding SGLT2is, 2,287 patients were prescribed these medications: 343 patients were prescribed dapagliflozin (188 at the 5 mg dose and 155 at the 10 mg dose); one patient received ertugliflozin at the 5 mg dose; 634 patients were prescribed canagliflozin (404 at the 100 mg dose, 173 at the 300 mg dose, 40 at the 50 mg dose with metformin combination, and 17 at the 150 mg dose with metformin combination); and 1,309 patients were prescribed empagliflozin (972 at the 10 mg dose, 333 at the 25 mg dose, two at the 5 mg dose with metformin combination, and two at the 12.5 mg dose with metformin combination). Cardiologists prescribed only 10.0% of SGLT2is, while internal/family medicine physicians accounted for the majority (52.3%) of prescriptions.

Conclusions

Robust evidence supports the use of sacubitril/valsartan and SGLT2is in HF, with both also proving effective for treating other diseases commonly coexisting with HF. The observed dosing patterns and distribution of prescribers reflect the broad utility of these novel therapeutics in diverse clinical settings.