2.6.3 Sodium-glucose co-transporter 2 (SGLT2) inhibitor

Prescribing may continue in primary care following initiation by a heart failure specialist.

For the use of dapagliflozin or empagliflozin in diabetes click here

For the use of Dapagliflozin in chronic kidney disease click here (links to NICE TA) and Kent and Medway Primary Care Guidance - Dapagliflozin for Chronic Kidney Disease in Adults (here)

K&M Implementation of NICE TA’s – SGLT2 inhibitors (Dapagliflozin & Empagliflozin) in the treatment of chronic heart failure

NICE TA679 (February 2021) - Dapagliflozin for treating chronic heart failure with reduced ejection fraction.

NICE TA773 (March 2022) - Empagliflozin for treating chronic heart failure with reduced ejection fraction.

NICE TA902 (June 2023) - Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction.

NICE TA929 (November 2023) - Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction.

To ensure clarity for clinicians and promote equitable access, the Kent and Medway Medicines Optimisation Team recommends that:

1. SGLT2 inhibitors (Dapagliflozin & Empagliflozin as per NICE TAs), when used to treat chronic heart failure with preserved, mildly reduced, OR reduced ejection fraction, is initiated by/on the advice of a heart failure specialist, with follow on prescribing in primary care.

2. Where specialist community heart failure teams exist, SGLT2 inhibitors (Dapagliflozin & Empagliflozin as per NICE TAs) may be initiated by the team following consultation with a (consultant led) specialist heart failure multidisciplinary team (MDT), with a clear audit trail of such consultation.

3. For patients with comorbidities e.g., diabetes, multi-speciality MDTs would be appropriate.

4. Monitoring requirements and discontinuation criteria should be set out at initiation and clearly communicated to the clinician who continues with the prescribing of SGLT2 inhibitors (Dapagliflozin & Empagliflozin as per NICE TAs).