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

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.