Secular trends in the utility of SGLT-2 inhibitors in heart failure patients with type 2 diabetes mellitus across Metro South Health hospitals in South-East Queensland.

BACKGROUND: The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown. AIMS: To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland. METHODS: Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021. RESULTS: A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m2 (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01). CONCLUSIONS: During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.

Frequency of urinary incontinence in people with chronic heart failure.

OBJECTIVES: The purpose of the study was to examine the frequency and severity of urinary incontinence in people with heart failure (HF). Secondary aims were to determine the differences in known risk factors for those who were continent and incontinent, to investigate the correlates of urinary incontinence in people with HF, and to examine the relationship between urinary incontinence with medication adherence, in particular, diuretics, and quality of life. BACKGROUND: Urinary incontinence is a common condition affecting older adults. However, the frequency of incontinence in people with HF remains largely unknown. METHODS: This was a descriptive study. A convenience sample of 181 people with HF were surveyed to determine frequency, severity and presence of risk factors of urinary incontinence and dosages of prescribed HF medications. Instruments included the Revised Urinary Incontinence Scale, Medication Adherence Report Scale and Incontinence Impact Questionnaire Short Form. Regression analyses were used to examine relationships between variables and presence of urinary incontinence. RESULTS: Eighty-nine people responded (66% male, mean age 67 years), 44 (49%) self-reporting urinary incontinence. Of these, 30 (34%) respondents rated their incontinence severity as slight or moderate. More incontinent respondents took furosemide doses greater than 20 mg daily (P = 0.046) and low doses of beta-blockers compared with continent respondents (P = 0.002). Taking low doses of beta-blockers explained 23% of variance for urinary incontinence (r(2) = 0.23, P = 0.015). Incontinent respondents reported altering or missing a diuretic dose (P < 0.02) compared with those who were continent. CONCLUSIONS: Frequency of urinary incontinence in this group of people with HF appears high. It appears that screening for urinary incontinence may be important as part of routine care in HF management programmes. In addition, awareness of dosages of furosemide and beta-blockers and in particular, adherence to diuretics also should be monitored. Prospective studies investigating these issues and the effect of targeted interventions are required.