Objective:

To evaluate whether completion of the Heart Failure Society of America Optimal Medical Therapy Certificate (HFSA OMT-Cert) by noncardiologist clinicians was associated with changes in encounter-level sodium-glucose cotransporter-2 inhibitor (SGLT2i) prescribing.

Approach:

• Study Design: This retrospective pre-post quality-improvement analysis included eligible adult patient encounters at a large integrated health system spanning Ohio and Florida.
• Intervention: HFSA OMT-Cert modules were distributed to primary care physicians, advanced practice providers, and clinical pharmacists practicing in primary care, general ambulatory, and postdischarge settings outside dedicated heart failure clinics.
• Outcome Measurement: The primary outcome was a new SGLT2i prescription issued by the certified provider within 10 days after an eligible encounter in which the patient was not already receiving an SGLT2i.
• Statistical Analysis: Logistic regression with an exchangeable working correlation accounted for repeated encounters within patients. Prespecified exploratory analyses examined encounters with left ventricular ejection fraction (LVEF) ≤40% and >40%.

Key Findings:

• Among 68 clinicians who completed OMT-Cert, 2,884 eligible encounters involving 1,891 unique patients were identified.
• New SGLT2i prescriptions increased from 5.9% of eligible encounters before certification to 9.6% after certification, an unadjusted absolute difference of 3.7 percentage points.
• Postcertification encounters had 1.29-fold greater odds of a new SGLT2i prescription (95% CI, 1.00-1.65; P = .046).
• In exploratory subgroup analyses, the association was nominally significant among encounters with LVEF ≤40% (OR, 1.86; 95% CI, 1.19-2.92; P = .006) but not among those with LVEF >40% (OR, 1.18; 95% CI, 0.85-1.65; P = .32).

Interpretation:

HFSA OMT-Cert completion was associated with a modest increase in new SGLT2i prescribing by noncardiologist clinicians. However, the primary estimate was of borderline statistical significance, the confidence interval approached unity, and postcertification prescribing remained low in absolute terms. The stronger signal among encounters with LVEF ≤40% was exploratory and hypothesis-generating rather than evidence of efficacy in that subgroup.

Limitations:

• The uncontrolled pre-post design lacked a contemporaneous comparison group and cannot establish that certification caused the prescribing increase.
• SGLT2i use increased substantially during the study period, so secular prescribing trends may explain part of the observed association.
• The pre- and postcertification populations differed modestly in LVEF and systolic blood pressure, and unmeasured local initiatives or other confounding factors could not be excluded.
• The analysis could not determine whether the association reflected greater knowledge, confidence, guideline awareness, or workflow changes.
• SGLT2i prescribing was the single prespecified outcome; other guideline-directed medical therapy classes were not evaluated.

Conclusion:

Completion of HFSA OMT-Cert was associated with a modest increase in new SGLT2i initiation among noncardiologist clinicians, with the strongest signal in exploratory analyses of encounters with LVEF ≤40%. The findings support further controlled evaluation of structured education as one component of multilevel strategies to improve guideline-directed medical therapy implementation.