Deepak L. Bhatt, MD, MPH, outlines the benefits of starting patients on sodium glucose co-transporter 2 (SGLT2) inhibitors while they are hospitalized.
Results of SOLOIST proved that it was safe to initiate sodium glucose co-transporter 2 (SGLT2) inhibitors in hospitalized patients, Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School.
Transcript
Can you elaborate on the importance of initiating sodium glucose co-transporter 2 inhibitors while patients are still in the hospital?
The in-hospital initiation of SGLT2 inhibitors, I think is really an important concept. We proved in sick patients with acute decompensated heart failure in SOLOIST that it was safe to initiate SGLT2 inhibitors in the hospital. And of course, it was specifically sotagliflozin, but I think that would be a generalizable to all the SGLT2 inhibitors. Now there are specific trials of empagliflozin and dapagliflozin and early initiation of those drugs that are ongoing, so we'll get more data on the topic. But I think the data from SOLOIST are actionable now. I would recommend in patients who are otherwise good candidates for SGLT2 inhibitors that don't have contraindications, when possible, to initiate SGLT2 inhibitors in the hospital.
Now there can be some logistical issues. Is what you have on the inpatient formulary the same as the outpatient formulary that the patient will be on? You want to make sure that there's not going to be awkward switching or so forth of drugs that will need to happen that could lead to errors or dosing errors or stuff like that. But putting that aside as a medical and scientific principle, the data from SOLOIST are in and I think we've shown that it is quite safe in stabilized inpatients—in that case, stabilized from a heart failure admission—to initiate an SGLT2 inhibitor as long as it's done carefully with monitoring I'm not saying we just be cavalier about initiation, what's started in a volume-depleted hypotensive patient. But again, in somebody that's an inpatient heading toward discharge, I think getting on that SGLT2 inhibitor is safe and in the case of patients with diabetes and heart failure, highly efficacious, as we showed in SOLOIST.
Beyond what we showed and studied in the trial, the other important part is if the patient started as an inpatient, I think they're more likely to be adherent, as other studies and other therapeutic classes have shown, because that patient thinks that drug is important. They just came into the hospital sick with heart failure, the doctor started them on an SGLT2 inhibitor, it must be important. And the other part is, as we just showed in SOLOIST, there's a very early benefit. The results were statistically significant in SOLOIST by 28 days. So sure, you can say I'll start the SGLT2 inhibitor in a month or 3 months or 6 months, that's better than not starting it in appropriate patients without contraindications. But if you could have started it in house, as we did in SOLOIST, those events that would have otherwise occurred in that first month, some of them could have been prevented.
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Joanne Mizell: Lifestyle Modification Programs Take Holistic Aim at Metabolic Disease
May 1st 2024Joanne Mizell shares insurer strategies in addressing the escalating rates of metabolic diseases, highlighting the importance of holistic treatment methods like lifestyle modification programs, which integrate nutrition, physical activity, and community engagement.
Read More
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More