Patient and prescriber knowledge of SGLT2i sick day rules: a single centre cohort study
B Woolfenden, M A Ashfaque, K Mcgoldrick, E O'rourke, H Raftery, B McadamAbstract
Background
Sodium Glucose Co-transporter 2 inhibitors (SGLT2i) have seen a dramatic increase in usage in recent years based on cardiovascular and renal studies and are now Class I recommendations in the European Society of Cardiology (ESC) heart failure guidelines. A known complicating factor with SGLT2i’s is the requirement of adherence to "sick day rules", which specify that a patient should hold their medication while unwell.
Purpose
Our purpose for this study was to assess patient’s knowledge and adherence to sick day rules for SGLT2i’s, and to assess prescriber compliance in holding these agents in appropriate clinical situations.
Methods
We performed a single centre snapshot cohort study looking at inpatients in our hospital that were taking an SGLT2i. We screened inpatient prescriptions at our centre for those who were prescribed a SGLT2i, either Dapagliflozin, Empagliflozin or Canagliflozin. 1050 patients were screened over 4 week period and 64 patients (7%) were identified that were taking a SGLT2i. We interviewed each patient with three pre-specified questions to assess their knowledge of being on an SGLT2i. 4 (6%) of the above patients were unable to give appropriate responses, for example due to a cognitive impairment. They were asked specifically about the medication that they were taking and included the drug and brand name. We also assessed if there was infection and whether the SGLT2i had been held appropriately.
Results
Out of the 60 (94%) patients who were able to give appropriate responses, the mean age was 75 years old, and 69% of them were male. The average creatinine was 132µmol/L and average BNP was 7913. 63% and 35% were taking Dapagliflozin and Empagliflozin respectively and 2% were on Canagliflozin. The most common indication was for HF with 73% of the patients, followed by Diabetes Mellitus at 20% and CKD at 9%. 6% had more than one indication. In terms of patient knowledge of SGLT2i’s, 25% of patients were aware that they were taking the drug and 25% of patients were aware of indication for its use. 6 (10%) of patients were aware of when to hold the SGLT2i. 27 (93%) of patients who had an active infection had their SGLT2i held by their prescriber, indicating good adherence to sick day rules by physicians and the other 7% of cases were on surgical wards. 77% of patients were under a medical team. There were no cases of ketoacidosis. HF was the most common reason for admission at 20% of the patients, AKI was the reason for admission in only 6% of patients.
Conclusion
Our results demonstrate a deficiency in knowledge from our patients regarding their SGLT2i’s and sick day rules. Moreover, the majority of patients were not aware they were on an SGLT2i or its indication. This data demonstrates the need for further education for patients with regards to the use of these agents and ways to understand sick day rules and its rationale. We found that prescriber adherence to sick day rules was excellent on medical service.For image description, please refer to the figure legend and surrounding text.