Background Heart failure (HF) on maximal therapy has a high morbidity and mortality associated with it. An estimated 26 million individuals are affected by HF worldwide resulting in a high cost expenditure. SGLT2i have prognostic benefit in patients with HFrEF on top of conventional therapies, irrespective of glycaemic status. Recently the NICE guidelines have recommended Dapagliflozin (SGLT2I) as an option for treating patients with symptomatic HFrEF as an add-on to optimised standard care. We aimed to estimate the proportion of patients, presenting with HF, that would be eligible for SGLT2i within our busy district general hospital and moreover to create and disseminate local guidelines for initiating SGLT2i treatment.

Methods We conducted a retrospective review of patients presenting at our hospital with HF between April - August 2020 (n=251). Patients over 18, with or without type 2 diabetes (T2D), EF≤40% and eGFR≥30 were included as eligible for SGLT2i. Patients with type 1 diabetes (T1D) and death during admission were excluded. 101/251 (40%) individuals had HFrEF. Parameters evaluated were demographics, eGFR, HbA1C, NT-ProBNP alongside regular medications.

Results 89% (n=90/101) met the inclusion criteria (68 (67%) male, mean (± SD) age 71.3 (±13.4). 11 (10%) had eGFR <30 and 1 (1%) had T1D, hence were excluded. 36 (37%) had T2D. The median (IQR) HbA1c was 52 (40-56) mmol/mol, mean (± SD) eGFR 51 (±20) mL/min/1.73m2 and median (IQR) NT-ProBNP 7482 (3117.5–18512.8) pg/mL. Median (IQR) length of hospitalization was 6 (3.5 - 11) days. Mortality was 10.9% (n=11/101) at 3-months. On discharge, HF therapy included Angiotensin-converting enzyme inhibitor/Angiotensin receptor blocker/Angiotensin receptor-neprilysin inhibitor (78%), Beta-blocker (89%), Mineralocorticoid-receptor antagonist (40%) and diuretic (91%)). Based on previous studies, SGLT2i would reduce mortality by 2.3% (n=2 patients in this cohort).

Conclusion Our study reveals that up to 9 in 10 individuals with HFrEF are suitable for SGLT2i. Poor renal function is a limiting factor. To achieve optimal success, intensive education for patients and multi-disciplinary team on benefits and possible complications with a designed pathway is essential.

Conflict of Interest none