Multidisciplinary care: A missing solution to SGLT2 inhibitor underuse in heart failure

We commend the authors of the RED-HEART study for their valuable contribution detailing real-world use of sodium–glucose co-transporter 2 inhibitors (SGLT2is) in heart failure patients.¹ Their identification of factors influencing SGLT2i prescription provides important clinical insights.

The authors rightly acknowledge as a limitation that their study included only patients managed in cardiology outpatient clinics. However, this limitation also represents a missed opportunity to explore how multidisciplinary care models might address the underuse of SGLT2is, particularly in patients with chronic kidney disease or diabetes. These populations often require co-management by nephrologists and endocrinologists, specialists with considerable experience prescribing SGLT2is.

Recent heart failure guidelines emphasize the importance of integrated, team-based approaches to optimize guideline-directed medical therapy. Multidisciplinary clinics and shared-care pathways have been shown to reduce therapeutic inertia and improve medication uptake in complex patients. The absence of analysis or discussion of multidisciplinary care as a potential enabler of higher SGLT2i use leaves a gap in interpreting the real-world barriers and solutions.

Future studies should evaluate how collaborative care models involving cardiology, nephrology and endocrinology influence the implementation of SGLT2 inhibitors in routine practice. Such research may help overcome barriers identified in RED-HEART and improve equitable access to these life-saving therapies.

Sincerely,

Dr. Wahab Khawar Siddiqui

Jinnah Sindh Medical University

[email protected]

None.