Abstract: TH-PO1046
Targeted Clinician Emails to Promote SGLT2 Inhibitor Re-initiation after Discontinuation for Remediable Side Effects
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Sanghavi, Sarah F., VA Puget Sound Health Care System Seattle Division, Seattle, Washington, United States
- Deval, Neha, Sea Mar Community Health Centers, Seattle, Washington, United States
- Nguyen, Ethan, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, United States
Background
Despite well-established efficacy in decreasing progression of kidney disease, SGLT2i therapy is discontinued in up to 60% of patients at 2 years. The purpose of this study was to identify veterans who had indications for SGLT2i reinitiation and remediable side effects. We then performed an intervention designed to educate the discontinuing clinician and resume therapy.
Methods
We identified patients from the VA Puget Sound Healthcare System who had a prescription for an SGLT2i discontinued between 1/1/2019 and 2/1/2023. Charts were manually reviewed to determine the reason for discontinuation and indications for therapy. Indications were defined as CAD or CHF, albuminuria > 30 mg/g, and eGFR < 60 ml/min. If the reason for discontinuation was remediable, patient specific e-mails were sent to the primary care provider or the discontinuing clinician outlining the reason for discontinuation and rationale for a second trial of the medication.
Results
The medical records of 805 veterans who discontinued therapy within the 4-year period were reviewed. After removal of records for discontinuation due to death or transfer to another VA, 435 records remained. The most common causes for discontinuation were genital infection (62), urinary frequency (60), volume depletion (53), decline in eGFR (30), and GI symptoms (23). We identified 99 patients with an indication to resume SGLT2i therapy and remediable side effects. Within 3 to 9 months of clinician e-mail notification, 26/99 veterans had resumed treatment.
Conclusion
We found that 23% of veterans who discontinued SGLT2i therapy had an indication for treatment and remediable side effects. Targeted e-mails to clinicians resulted in resumption of medication in 26% of veterans within 3-9 months of notification suggesting benefit of the intervention. Longterm data are needed to determine if this effect is durable.
| Most Common Side Effects | Discontinued N=435 | E-mail Sent N=99 | Reinitiation N=26 |
| Genital Infections (Suspected or Confirmed) | 62 | 6 | 0 |
| Urinary Frequency | 60 | 22 | 5 |
| Volume Depletion | 53 | 15 | 6 |
| Decline in eGFR | 30 | 12 | 4 |
| GI Symptoms | 23 | 6 | 2 |
| Urinary Tract Infection (Suspected or Confirmed) | 21 | 2 | 0 |
| Improved HbA1c | 20 | 4 | 1 |
| Suspected ketoacidosis | 16 | 3 | 1 |
| Hospitalization | 6 | 3 | 2 |
Funding
- Veterans Affairs Support