Aging
Sodium-Glucose Cotransporter-2 Inhibitor Use for Heart Failure Across Transitions between Community, Hospital, and Skilled Nursing Facility Settings Kelsey L Corcoran, DC* Kelsey Corcoran Corcoran Corcoran Corcoran Corcoran Corcoran Corcoran Corcoran Brown University School of Public Health
Background
Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2is) improve outcomes in heart failure (HF). The use of SGLT2d in skilled nursing facilities (SNFs), where nearly 25% of older adults are discharged following a HF hospitalization, is not well described.
Methods
This retrospective cohort study assessed SGLT2i exposure from June 28, 2017 to October 14, 2024 among older adults hospitalized for HF and discharged to SNFs contributing data to the Long-Term Care Data Cooperative. We examined SGLT2i exposure during the year prior to HF hospitalization and through 100 days after SNF admission. Medications were unobservable during hospitalizations. SGLT2is included were empagliflozin, dapagliflozin, and sotagliflozin, which are all FDA-approved for the management of HF. We defined inter-facility discontinuation as an SGLT2i dispensing in the pre-hospitalization setting that was not followed by an administration in the SNF. Intra-SNF discontinuation was defined as no SGLT2i administrations during the last 25% of SNF days for individuals with any administrations in the SNF.
Results
There were 187,878 individuals hospitalized for HF and discharged to SNFs. The mean (SD) SNF length of stay was 27.7 (26.5) days. Only 7,872 (4.2%) of individuals received an SGLT2i at any point, with 4,789 (2.5%) administered the drug during SNF stay. Approximately 75% of SGLT2i initiations occurred in the pre-hospitalization setting and 25% occurred during SNF stays. Among those taking an SGLT2i in the pre-hospitalization period, 39.2% (3,083/5,877) had an inter-facility discontinuation (Figure 1). Intra-SNF discontinuations occurred among 4.8% (231/4,789) of individuals who had an SGLT2i administration in the SNF.
Conclusion
SGLT2i use is low among individuals discharged to SNF after a HF hospitalization. Inter-facility SGLT2i discontinuation occurs commonly. These patterns may reflect individualized prescribing in a high-risk population, missed opportunities to improve therapy, or both.
