Clinical Scorecard: The Relationship Between Completion of HFSA Optimal Medical Therapy Certification and the Prescription of Sodium-Glucose Cotransporter-2 Inhibitors

At a Glance

Key Highlights

• The analysis included 2,884 eligible encounters involving 1,891 unique patients and 68 OMT-Cert–certified clinicians.

• New SGLT2i prescriptions increased from 5.9% of eligible encounters before certification to 9.6% afterward.

• Postcertification encounters had 1.29-fold greater odds of a new SGLT2i prescription, although the result was of borderline statistical significance.

• The strongest association occurred in an exploratory analysis of encounters with LVEF ≤40%.

• Postcertification prescribing remained low in absolute terms, at 9.6%.

Guideline-Based Recommendations

Diagnosis

• The study evaluated prescribing behavior rather than heart failure diagnosis.

• SGLT2i prescribing was examined across the ejection-fraction spectrum.

Management

• SGLT2 inhibitors are a core component of contemporary guideline-directed heart failure therapy.

• Structured clinician education may be incorporated as one component of a multilevel implementation strategy.

• The study does not establish that OMT-Cert completion caused the observed prescribing increase.

Monitoring & Follow-up

• OMT-Cert covers guideline-directed therapy indications, dosing, contraindications, monitoring, and adverse effects.

• Intensive heart failure management strategies may include frequent reassessment and titration of guideline-directed therapy.

• The study did not evaluate patient monitoring or clinical outcomes after SGLT2i initiation.

Risks

• The article did not assess SGLT2i adverse events or medication safety outcomes.

• Secular increases in SGLT2i adoption may account for part of the observed prescribing difference.

• Education alone may be insufficient to overcome the multiple barriers to guideline-directed therapy implementation.

Patient & Prescribing Data

The analysis included 2,884 eligible encounters involving 1,891 patients. Overall, 71.2% of encounters involved patients aged 65-89 years, 55.1% involved male patients, and 45.2% involved patients with type 2 diabetes.

New SGLT2i prescriptions were issued in 215 eligible encounters: 100 of 1,686 encounters before certification and 115 of 1,198 encounters afterward.

Clinical Best Practices

• Interpret the prescribing increase as an observational association rather than a causal effect of certification.

• Regard the LVEF ≤40% subgroup result as exploratory and hypothesis-generating.

• Position structured education alongside clinical decision support, team-based workflows, medication-access infrastructure, performance feedback, and structured follow-up.

• Further controlled studies are needed to determine the effect of OMT-Cert on prescribing behavior.

Related Resources & Content

1. The Association of Heart Failure Society of America Optimal Medical Therapy Certification Completion With Sodium-Glucose Cotransporter-2 Inhibitor Prescribing — Chapman B, Patolia H, Ryan D, et al. Journal of Cardiac Failure. 2026. doi:10.1016/j.cardfail.2026.06.010.

2. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure — Heidenreich PA, Bozkurt B, Aguilar D, et al. Journal of the American College of Cardiology. 2022;79:e263-e421.

3. A Heart Failure Society of America–Developed Educational Module Improves Clinician Comfort With Initiation and Optimization of Guideline-Directed Medical Therapy — Chapman B, Albert NM, Zajichek A, et al. Journal of Cardiac Failure. 2025;31:1593-1597.

4. Interventions for Optimization of Guideline-Directed Medical Therapy: A Systematic Review — Tang AB, Brownell NK, Roberts JS, et al. JAMA Cardiology. 2024;9:397-404.

5. Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice: A Cluster Randomized Trial — Ghazi L, Yamamoto Y, Riello RJ, et al. Journal of the American College of Cardiology. 2022;79:2203-2213.