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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement

  • Ahmad Karzoun1
  • Hamza Alkowatli1
  • Olu Oyesanmi2
  • Robert Subbiondo3
  • Hakan R. Toka4
4 affiliations
  1. 1Department of Internal Medicine, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA
  2. 2West Florida Division, HCA Healthcare Research and Innovation Department, Tampa, Florida, USA
  3. 3Department of Cardiovascular Disease, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA
  4. 4Department of Nephrology, HCA Florida Blake Hospital/USF Morsani College of Medicine GME Consortium, Bradenton, Florida, USA
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Abstract

Background: Despite strong evidence supporting dapagliflozin 10 mg daily for heart failure with reduced ejection fraction, variation in prescribing practices persists.

Project Rationale: Institutional review identified frequent use of non–guideline-supported dapagliflozin 5 mg dosing and demonstrated that inpatient dose selection strongly influenced discharge prescribing patterns.

Project Summary: A multidisciplinary quality improvement intervention consisting of electronic medical record redesign, provider education, and pharmacist-led discharge verification was implemented on December 15, 2025. Among 124 preintervention patients, 83.9% received inpatient dapagliflozin 10 mg and 16.1% received 5 mg. Following intervention, guideline-concordant 10-mg prescribing increased to 92.0% and 5-mg prescribing decreased to 8.0%. Inpatient dose remained significantly associated with discharge prescribing behavior (P = 0.0467).

Take-Home Messages: System-level workflow redesign improved adherence to guideline-concordant dapagliflozin prescribing and reduced non–evidence-based low-dose use. Similar implementation strategies may improve delivery of guideline-directed medical therapy in heart failure.

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Cite

BibTeXRIS
BibTeX
@article{karzoun2026improving,
  title = {{Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement}},
  author = {Ahmad Karzoun and Hamza Alkowatli and Olu Oyesanmi and Robert Subbiondo and Hakan R. Toka},
  journal = {JACC Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1016/j.jaccas.2026.109545},
  url = {https://doi.org/10.1016/j.jaccas.2026.109545},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Improving Dapagliflozin Dosing in Heart Failure Through System-Level Quality Improvement
AU  - Ahmad Karzoun
AU  - Hamza Alkowatli
AU  - Olu Oyesanmi
AU  - Robert Subbiondo
AU  - Hakan R. Toka
PY  - 2026
DA  - 2026/09/16
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109545
UR  - https://doi.org/10.1016/j.jaccas.2026.109545
AB  - Background: Despite strong evidence supporting dapagliflozin 10 mg daily for heart failure with reduced ejection fraction, variation in prescribing practices persists.  Project Rationale: Institutional review identified frequent use of non–guideline-supported dapagliflozin 5 mg dosing and demonstrated that inpatient dose selection strongly influenced discharge prescribing patterns.  Project Summary: A multidisciplinary quality improvement intervention consisting of electronic medical record redesign, provider education, and pharmacist-led discharge verification was implemented on December 15, 2025. Among 124 preintervention patients, 83.9% received inpatient dapagliflozin 10 mg and 16.1% received 5 mg. Following intervention, guideline-concordant 10-mg prescribing increased to 92.0% and 5-mg prescribing decreased to 8.0%. Inpatient dose remained significantly associated with discharge prescribing behavior (P = 0.0467).  Take-Home Messages: System-level workflow redesign improved adherence to guideline-concordant dapagliflozin prescribing and reduced non–evidence-based low-dose use. Similar implementation strategies may improve delivery of guideline-directed medical therapy in heart failure.
SN  - 2666-0849
ER  -