Purpose: Evaluate the impact of inpatient pharmacist interventions on SGLT2 inhibitor initiation in hospitalized heart failure patients and compare pre- and post-intervention rates, pharmacist involvement, barriers, and 30-day readmissions. Methods: This retrospective, pre- and post-quality improvement study included adult patients hospitalized with heart failure over two six-week periods. Data collected included demographics, heart failure classification, laboratory values, guideline-directed medical therapy (GDMT), pharmacist interventions, and 30-day readmissions. The intervention consisted of increased inpatient pharmacist involvement through chart review, documentation, medication recommendations, discharge counseling, and assistance with medication access. Statistical analyses included chi-square tests for categorical variables and t-tests for continuous variables. Results: A total of 164 pre- and 170 post-intervention patients were included. Baseline demographics and clinical characteristics were similar between groups. Pharmacist interventions significantly increased from 7.3% pre-intervention to 21.3% post-intervention (p<0.001).
SGLT2 inhibitor use at discharge remained similar between groups (28.0% vs 27.2%, p=0.866), and initiation rates during hospitalization did not significantly change (12.2% vs 12.4%, p=0.949). Other GDMT utilization also showed no statistically significant differences. However, 30-day readmission rates increased from 34.8% pre-intervention to 48.5% post-intervention (p=0.011). Barriers to SGLT2 inhibitor initiation were similar between groups (32.9% vs 30.8%). Conclusion: Inpatient pharmacist involvement significantly improved documentation and intervention rates but did not result in increased SGLT2 inhibitor initiation. Despite enhanced pharmacist engagement, no reduction in 30-day readmissions was observed. These findings show persistent barriers to therapy initiation suggesting additional strategies beyond pharmacist intervention may be necessary to improve clinical outcomes in heart failure patients. Authorship: Katherine Ghattas, PharmD; James Helms, PharmD, BCPS; Bonny Brownstein, PharmD, BCPS, BCPPS
