Background and Importance Protocol for use of dapagliflozin was approved for the adult treatment of symptomatic chronic heart failure with reduced left ventricular ejection fraction (LVEF) in patients uncontrolled with first-line therapies, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) with beta blockers, and second-line therapies, aldosterone antagonists.
Aim and Objectives To evaluate the use of dapagliflozin in the treatment of heart failure in hospitalised patients, assessing the degree of prescription compliance with the protocol agreed upon by the Pharmacy and Therapeutics Committee.
Material and Methods Retrospective observational study between December 2021 and April 2022 of hospitalised patients who started treatment with dapagliflozin. The study variables were: sex, age, reason for admission, presence of heart failure with LVEF <40%, concomitant treatment with ACEI, ARB, beta blockers, aldosterone antagonists, positive inotropics, sacubitril/valsartan or diuretics, and presence of diabetes with or without antidiabetic treatment. Clinical data were obtained from the Orion-Clinic® electronic medical record program.
Results In the period evaluated, 61 patients initiated dapagliflozin 10 mg per day, 42 men (69%), with a median age of 76 years (IQR 84-66). A total of 46 patients (75%) presented heart failure on admission and the rest were admitted for other cardiac pathology. Only 38 patients (62%) had an LVEF registry, of which 22 patients (36%) had an LVEF < 40% with a median LVEF of 32% (IQR 35-25). Forty-four patients (72%) were diabetic and 6 patients (17%) were treated with dapagliflozin in combination with metformin. For the study of concomitant treatments: 22 patients (36%) were prescribed ACEI/ ARB, 38 patients (62%) beta blockers, 8 patients (13%) positive inotropics, 21 patients (34%) aldosterone antagonist diuretics, 41 patients (67%) loop/thiazide diuretics and 9 patients (14.8%) sacubitril/valsartan. To highlight, 11 patients (18%) were being treated with the combination ACEI/ARA-II+beta blockers+aldosterone antagonist. Finally, only 35 patients (57%) continued with dapagliflozin as discharge treatment.
Conclusion and Relevance The degree of adequacy of dapagliflozin prescription to the approved protocol for use was high but an appreciable percentage of patients do not adhere to the inclusion criteria, indicating that the protocol recommendations should be revised to ensure effective use of dapagliflozin. Only half of the patients who initiated treatment continued after discharge.
Conflict of Interest No conflict of interest
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