4CPS-194 Baseline audit of potential to optimise therapy through use of SGLT2i in a cohort of patient admitted with an acute myocardial infarction. Issue 1 (23rd March 2023) - Ben Hajmessaoud, N
Abstract : Background and Importance: There are around 100, 000 hospital admissions each year in the UK due to acute myocardial infarctions (AMI). Co-morbidities in those with ischaemic heart disease are common and include heart failure, diabetes and chronic kidney disease (CKD), the interplay between these conditions being recently termed cardiometabolic syndrome. Recent updates in UK NICE guidance support the use of SGLT2i for those with type II diabetes (T2DM) and cardiovascular (CV) risk, for treatment in those with heart failure with reduced ejection fraction and most recently for CKD. Aim and Objectives: Assess patients at a large London based cardiovascular centre, being previously discharged with a diagnosis of AMI to identify the opportunity to optimise therapy through prescribing SGLT2i. Material and Methods: Retrospective analysis of patients admitted with an AMI between January and October 2021 at a large London based cardiovascular centre to compare the optimisation of SGLT2i at discharge (DC) and at 12 months in those with cardiometabolic risk factors (i.e T2DM, HF and CKD). Results: 450 patients with AMI were followed during 1 year, average aged of 57.3 years old with 84% male, T2DM (25.7%), HF (23.5%), CKD (10%), 43% smokers and 3% with AF. At discharge, SGLT2i were prescribed in 4.6% of all AMI patients. In patients with T2DM, HF and CKD, the respective rates of SGLT2i at discharge were 18%, 3.7% and 2.2%. At 12 months post-discharge, T2DM increased to 28% (11 newly diagnosed), 23.5% of patients with HF and 16% with CKD (26 patients newly diagnosed). SGLT2i were prescribed in 10.4% of patients with respective rates of 30%, 16% and 11.1%. Conclusion and Relevance: This data supports an opportunity to improve SGLT2i prescribing in our post-MI cohort with additional cardiometabolic risk factors. There was a small increase in prescribing noted after 12 months but recent updates in UK policy would support a wider adoption of SGLT2i use, in particular noting the high rates of T2DM and HF seen in the post-AMI group. Strategies to facilitate optimisation include protocolisation of initiation, communication for 1ry care physicians to start shortly after discharge and consideration of earlier initiation prior to discharge in those with cardiometabolic risk factors. References and/or Acknowledgements: Conflict of Interest: No conflict of interest