CONTINUED OPTIMIZATION OF USE OF SGLT-2I FOR HF: IMPROVING PRESCRIPTION REFILLS OF SGLT2I AT UT TYLER INTERNAL MEDICINE RESIDENT CLINIC

Other: Quality Improvement - Heart Failure Heart failure (HF) patients face a significantly increased risk of hospitalization and cardiovascular (CV) death. Sodium-glucose transport inhibitors (SGLT2i) have been shown to reduce the risk of hospitalizations and CV death in patients with HF. They are now a staple in evidence-based medical therapy for HF. Various trials have examined the risk of hospital readmission and CV mortality, with EMPEROR-Reduced and EMPEROR-Preserved trials revealing that empagliflozin reduces hospitalization and CV death for HF patients with HFrEF and HFpEF with or without diabetes. The SOLOIST-WHF trial also showed that sotagliflozin, prescribed before or shortly after discharge, decreases the total number of CV deaths and rehospitalizations secondary to HF. However, residents may be under prescribing and refilling SGLT2i for patients with HF in the outpatient setting possibly due to being unaware of the newest guidelines, lack of continuity with the patient, or lack of comfort with prescribing SGLT2i for HF. At the UT Tyler Internal Medicine (IM) Resident Clinic, the majority of patients fall into a low socioeconomic status category. Thus, it was pertinent that we expand on increasing the prescription of SGLT2i but also investigate the overall prescription refills to ensure continued compliance and optimization of pharmacological therapy. This resident-led quality improvement project aims to increase the rate of SGLT2i refills in patients with HF in the UT Tyler IM Resident Clinic by 3% from a baseline of 17.5% within 3 months. Using a fish-bone diagram, root-cause analysis was performed for different reasons SGLT2i are under-prescribed by residents. A Pick Chart was used for intervention planning which involved reminders on conference tables aimed at the preceptor and resident during report out. Datasets were pulled from EPIC EMR. A baseline percentage rate of prescription refills of SGLT2i in patients with ICD codes indicating diagnosis of HF was obtained from January 1, 2023 to October 1, 2023 and then again post-intervention during a 3-month period. At baseline, the number of refills of SGLT2i sent by residents for patients with the diagnosis of HF was discovered to be 17.5%. Following the first PDSA cycle, the number of prescription refills of SGLT2i sent by residents between October 1, 2023 and January 16, 2024 had increased to 22.4% indicating an increase of 4.9% from baseline. At the IM resident clinic, our goal has been t