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Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are antihyperglycemic medications with cardiovascular disease and renal protective properties. While clinical trials supporting their efficacy, the utility among safety-net health system patients with low health literacy has not been evaluated. We sought to assess appropriate monitoring, safety and effectiveness of GLT2i initiation at a safety-net hospital. From May 2017 to July 2020, 150 patients were newly initiated on an SGLT2i therapy. We evaluated appropriate initiation, laboratory monitoring, impact on urine microalbumin, mean hemoglobin A1c (HbA1c), and systolic blood pressure (SBP). We also analyzed primary care versus subspecialty prescriber patterns. All patients did not have prohibitive renal dysfunction based on Food and Drug Administration labeling and the majority (N = 101, 67%) had renal function testing completed before initiation. Improvement in cardiovascular disease surrogate markers including SBP (mean, -3.12 mm Hg), albuminuria (mean, -3.98 mg/dL), and HbA1c (mean, -1.06%) were observed. A total of 94% of the cohort had serum chemistry panels drawn, yet only 4% were performed within the protocol-specified (14-day) period. Primary care and cardiology providers were the sole prescribers; despite the known renoprotective properties, no patients were initiated on SGLT2i therapy by a nephrologist. In conclusion, the benefits of SGLT2i drugs reducing SBP, albuminuria, and HbA1c observed in clinical trials were duplicated in our safety-net population. Therefore, ongoing education and promotion to providers to ensure broadened utilization and timely renal function monitoring appear warranted.

Outcomes and process of care for acute myocardial infarction (AMI) may vary by sociodemographic status. In particular, both low income and uninsured status are common among patients cared for by the nation's safety net hospitals. These characteristics have been linked with delays in seeking care for an AMI. However, less is known about the characteristics and risk factor control among vulnerable patients prior to their index event. Given this background, we assessed cardiac risk factor control before admission, and evidence-based medical care at discharge, following an index AMI event within an urban safety net hospital. Prior to hospitalization, 25% of patients were not integrated into our safety net system and had suboptimal risk factor control. Despite this, inhospital conformity with AMI performance measures were excellent, with 95% of eligible patients receiving a composite criterion of aspirin and β-blockers on admission and discharge. A majority of AMI survivors were successfully integrated into our system postdischarge.

Cardiovascular disease (CVD) is the leading cause of death in the United States and is often attributable to poorly controlled yet modifiable risk factors. All national guidelines strongly recommend performing global CVD risk assessments to inform therapeutic intensity, but only a minority of clinicians regularly quantitate their patient's CVD risk. Not surprisingly, many patients are not at goal with regard to blood pressure, lipids, and the appropriate receipt of antiplatelet therapy. Given this background, the Colorado Clinical Guidelines Committee partnered with the Colorado Prevention Center to craft a simple algorithm for CVD risk reduction that emphasizes risk quantification and aggressive treatment for established CVD. The Colorado Clinical Guidelines Committee assembled a multidisciplinary team of health professionals with the goal of creating a comprehensive primary and secondary prevention framework that targets primary care physicians. We described the rationale, methods, and ultimate deployment of this guideline statewide in Colorado and hope this process may be a resource to other states interested in harmonizing a public health approach to CVD risk reduction.

Chest pain observation units are increasingly used to evaluate patients at low risk for cardiovascular events and are commonly staffed by cardiologists. The role of hospitalists in this setting has not been described. We assessed emergency department (ED) length of stay before and after adding hospitalists to the care team among 493 patients. Prior to intervention, median ED length of stay was 19.3 hours, which decreased to 11.0 hours with the addition of hospitalists (43% decrease, P

Primary percutaneious coronary intervention (PCI) is rapidly becoming the preferred therapy for acute ST-segment elevation myocardial infarction (AMI) because of a lower mortality rate and decreased hospital length of stay (LOS) compared with thrombolysis. However, generalizability of these findings beyond randomized trials involving specialized centers has not been well described. Many urban county hospitals care for disadvantaged patients and lack on-site PCI capabilities. Moreover, treatment delays and worse clinical outcomes have been demonstrated in this population. We sought to determine whether a shift from uniform on-site thrombolysis to off-site PCI for disadvantaged AMI patients reduces hospital LOS. We retrospectively reviewed 91 AMI patients presenting to an inner-city hospital without PCI capabilities, comparing 47 consecutive patients treated with off-site PCI with 44 historical controls who received thrombolysis. The primary end point was hospital LOS. Multivariable regression was used to adjust for baseline differences between the groups. Unadjusted median LOS was lower in the PCI group than the thrombolytic group (4 versus 6 days, P = 0.004). These differences remained after adjusting for variation in baseline sociodemographic and clinical characteristics including the presence of cardiogenic shock. Fifteen patients (34%) in the thrombolytic group required urgent catheterization during index hospitalization versus none in the PCI group (P < 0.001). No differences in death or nonfatal reinfarction were noted 6 months after index event. This study supports the usefulness of primary PCI beyond highly selected populations in randomized controlled trials. Specifically, PCI significantly decreases hospital LOS among vulnerable AMI patients.