What makes a good doctor probably depends on whom you ask. Patients value interpersonal relations, and being involved in decisions about their care. In contrast, hospital executives place an emphasis on the ability to meet key performance indicators critical to the flow of patients through hospitals.

Objective: Sodium-glucose co-transporter-2 inhibitors (SGLT2-I’s) are novel oral hypoglycaemic agents, with proven decreased MACE and re-hospitalisation risk in type 2 diabetic patients with concomitant heart failure. This study aimed to assess the current practice in the use of SGLT2-I’s in general medical units at a large metropolitan health service. Methods/Results: A retrospective audit was conducted of patients admitted to general medicine over a 12 month period (between April 2018 and 2019). Inclusion criteria included decompensated heart failure of any aetiology and ejection fraction, and type 2 diabetes mellitus with an HbA1c ⩾ 7 within 6 months of the admission period. A total of 150 admissions fulfilled criteria. Baseline demographics and comorbidities identified an older, more comorbid population than reference trials. These included age (75% over 75 years), smoking history (46%), hypertension (83%), chronic kidney disease grade IV or V (26%), previous myocardial infarction (57%), stroke (18%), atrial fibrillation (55%) and known left ventricular ejection fraction < 50% (38%). Co-prescribed medications included ACE-I/ARB (53%), beta-blocker (67%), loop diuretic (87%), thiazide (7%), MRA (31%), insulin (57%), metformin (47%), sulphonylurea (31%), DPP-4 Inhibitor (21%), GLP-1 analogue (6%) and 15% of patients had an HbA1c > 10. There was a significant difference between patients in our study eligible for and prescribed metformin (66/111) compared to SGLT-2 inhibitors (4/25) ( P = .013). A total of 26 patients had readmissions within 28 days, of which one had been discharged on an SGLT2-I. Conclusion: The results of this study identified significant under prescribing of SGLT2-I’s in eligible type 2 diabetic patients with heart failure admitted under general medicine.

A total of 150 admissions fulfilled criteria. Baseline demographics and comorbidities identified an older, more comorbid population than reference trials. These included age (75% over 75 years), smoking history (46%), hypertension (83%), chronic kidney disease grade 4/5 (26%), previous myocardial infarction (57%), stroke (18%), atrial fibrillation (55%), and known left ventricular ejection fraction,50% (38%). Co-prescribed medications included ACE-I/ARB (53%), beta-blocker (67%), loop diuretic (87%), thiazide (7%), MRA (31%), insulin (57%), metformin (47%), sulfonylurea (31%), DPP-4 Inhibitor (21%), GLP-1 analogue (6%), and 15% of patients had an HbA1c.10. There was a significant difference between patients in our study eligible for and prescribed metformin (66/111) compared to SGLT-2 inhibitors (4/25) (p=0.013). A total of 26 patients had readmissions within 28 days, of which one had been discharged on an SGLT2-I. Conclusion: The results of this study identified significant under prescribing of SGLT2-I's in eligible type 2 diabetic patients with heart failure admitted under general medicine.

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