169-OR: SGLT2 Inhibitor Prescribing Discrepancies in Patients with Diabetes Mellitus Type 2 and Heart Failure at an Academic Medical Center

With new indications for SGLT-2 inhibitors (SGLT2i) and efforts to minimize cardiovascular risk, there are concerns about equitable and timely distribution of SGLT2i. Inpatient initiation of SGLT2i is an important opportunity to optimize medical therapy. To better understand current prescribing practices, we compared patients started on a SGLT2i at time of discharge across two hospital sites in the 15 months after inclusion in the inpatient medication formulary. A retrospective chart review from February 2021 to May 2022 was performed of patients admitted to UC San Diego and discharged with a SGLT2i. Diagnosis was determined by ICD-10 code, and/or A1c during admission 6.5%. This cohort was compared to all patients admitted with an ICD-10 diagnosis of heart failure and/or DMT2. We examined patient demographics including age, gender, race/ethnicity, and differences between hospital sites (H1, H2). An SGLT2i was prescribed for 178 patients out of 1160 total admissions for CHF and 52,291 total admissions of individuals with DMT2. Of those who received an SGLT2i, 105 (58%) had diabetes, 151 (85%) had CHF and 82 (46%) had both. Between hospitals, 22% of patients with CHF at H1 v. 5% at H2 received an SGLT2i, and 0.22% of patients with diabetes at H1 and 0.17% at H2. The average age of those prescribed compared to the eligible population was 59 v. 64 for CHF and 60 v. 47 for DMT2. Women were less likely to be prescribed than men in both the heart failure (7% v. 16%) and DMT2 groups (0.1% v. 0.32%). The percentage of recipients (CHF, DMT2) by ethnicity was Asian (6, 0.08%), American Indian 0%, Black (7, 0.23%), Hispanic (19, 0.23%), Pacific Islander (26%, 0.81%), White 10, 0.17%). This analysis of SGLT2i initiation at hospital discharge indicates there are likely key differences in prescribing frequency between gender, ethnicities, and hospital sites. Continued collaboration amongst specialties and attention to implicit bias in prescribing practices is warranted.