Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of antidiabetic mediations found to also reduce cardiovascular morbidity and mortality and hospitalization for heart failure. Positive results from the EMPEROR-Preserved (empagliflozin) and PRESERVED-HF (dapagliflozin) studies led to recommendations for SGLT2 inhibitors in HFpEF within major international heart failure guidelines. However, studies of ipragliflozin and luseogliflozin, agents approved outside the United States (U.S.), reported different outcomes relative to pivotal trials and failed to realize benefits in the HFpEF population. Varying definitions of HFpEF and outcomes studied complicate the interpretation of study results. SGLT2 inhibitors may cause common adverse events (genital mycotic infections, volume depletion) in addition to rare but severe sequela, including euglycemic diabetic ketoacidosis, Fournier’s gangrene, and lower limb amputation. While evidence of CV benefits grows, SGLT2 inhibitor prescribing has lagged, particularly among patients without diabetes. In the U.S., high cost and administrative hurdles may contribute to decreased patient and clinician uptake of this drug class. Future trial results and clinical experience with SGLT2 inhibitors may lead to expanded use and greater uptake among patients with heart failure.

Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to signi cant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. MethodsThis single center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care while post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in ve areas: consults, inpatient interventions, education, transitions of care, and after discharge care. To ensure consistency of interventions, a formal checklist of items was maintained. ResultsIn this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort, 22.4% vs. 38.3% (p=0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p< 0.001) and 10.1% vs. 32.2% (p<0.001), respectively.

Purpose Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. Methods This single center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care while post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. To ensure consistency of interventions, a formal checklist of items was maintained. Results In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort, 22.4% vs. 38.3% (p=0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p< 0.001) and 10.1% vs. 32.2% (p<0.001), respectively. Conclusion Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.

Introduction: Pharmacists can provide a variety of discharge services that aid in transitions of care. The purpose of this study is to evaluate the impact of a pilot program implementing a unit-based clinical pharmacist at a community teaching hospital. Methods: This prospective study evaluated pharmacist-led discharge services on an adult medicine unit over a 5-week period. The control cohort received usual care, and the intervention cohort received additional pharmacy services (e.g., counseling, medication reconciliation, ensuring medication access, and overcoming discharge barriers). The primary outcome was 30-day all-cause hospital readmissions. Secondary outcomes included emergency department (ED) utilization, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and patient satisfaction survey scores. Results: Overall, 197 patients were included in the control group and 210 in the intervention group. Characteristics including previous hospital utilization, comorbidity count, and medication count at discharge were similar between groups. A reduction in 30day all-cause hospital readmissions was observed in the cohort receiving pharmacist intervention, 13.3% versus 20.8% (p 5 0.044). This study also demonstrated a significant decrease in ED utilization rates and improved patient satisfaction. Conclusions: This study adds to the growing body of literature supporting transition of care pharmacists in the hospital discharge model to improve patient care.