28 Hospital doctors’ knowledge of SGLT2 inhibitors in heart failure: a cross-specialty survey of awareness, side-effects, and perioperative management

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Background Sodium-glucose co-transporter-2 (SGLT2) inhibitors are now integral in the management of heart failure (HF) following robust evidence demonstrating cardiovascular and mortality benefits across HF phenotypes. However, growing use has highlighted safety concerns, particularly euglycemic diabetic ketoacidosis (EDKA), necessitating awareness of best practice guidelines, including the ESC/ESAIC 2022 recommendations to withhold SGLT2 inhibitors pre-operatively. Objective To evaluate hospital doctors’ knowledge and confidence in the use of SGLT2 inhibitors, with a focus on side-effects, sick-day rules, and perioperative management. Methods An anonymous survey was distributed among junior doctors across cardiology, anaesthesia, critical care, medicine, and surgery at a large teaching hospital, reflecting real world practices. The survey assessed awareness of SGLT2 inhibitors, management of EDKA, knowledge of sick-day rules, and adherence to ESC perioperative guidelines. Results A total of 92 junior doctors completed the survey. High recognition rates of SGLT2 inhibitors (96%) and awareness of their role in non-diabetic HF patients (87%) were observed. However, significant gaps emerged in confidence regarding side-effect management and counselling on sick-day rules, with notable inter-specialty variability. Regarding the management of SGLT2 inhibitors in sepsis, 88% of anaesthetic and critical care doctors, 91% of medical doctors, 100% of cardiologists and 75% of surgeons knew to hold SGLT2 inhibitors in sepsis. Regarding ESC perioperative guidelines, while 97% of respondents recognised the need to withhold SGLT2 inhibitors pre-operatively, only 32% correctly identified the recommended 72-hour withholding period, with speciality based response variation outlined in figure 1. Conclusions This study provides important information on junior doctors’ knowledge and knowledge gaps regarding SGLT2 inhibitors in HF. Although general awareness of SGLT2 inhibitors is high, uncertainties remain around side-effect management, sick-day rules, and perioperative guidance, with variability across specialties. These findings underline the need for targeted educational initiatives to ensure safe prescribing practices of SGLT2 inhibitors in HF populations, particularly around perioperative and acute illness settings.

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