Clinical ResearchUtilization Rates of SGLT2 Inhibitors Among Patients With Type 2 Diabetes, Heart Failure, and Atherosclerotic Cardiovascular Disease: Insights From the Department of Veterans Affairs
Central Illustration
Section snippets
Study population
This study used data from the nationwide VA administrative and clinical data set. The database comprises veterans aged >18 years with a diagnosis of ASCVD. Patients included in the cohort had at least 1 primary care visit between January 1, 2020, and December 31, 2020, at 130 VA facilities and their associated community-based outpatient clinics. If a patient had multiple primary care visits during the study period, the last primary care visit in the year 2020 was defined as the index visit.
Results
Among the total number of patients with ASCVD in our cohort (n = 1,235,567), we excluded patients with limited life expectancy (n = 32,106). Among these patients, 128,897 patients had ASCVD and concomitant T2DM and HF. We further excluded 23,098 patients with an eGFR of <30 mL/min/1.73 m2 and/or patients with type 1 diabetes. Our primary cohort included 105,799 patients with ASCVD with concomitant T2DM and HF. The overall use of SGLT2 inhibitors within our cohort was 14.6% (SD: 5.8; n = 15,428)
Discussion
In these analyses, we have demonstrated that in patients with high-risk comorbidities associated with a well-established SGLT2 inhibitor benefit (ASCVD, T2DM, and HF), only 15% were treated with SGLT2 inhibitors. Female patients, Black patients, patients with lower eGFR, and patients with PAD or ischemic cerebrovascular disease were less likely to receive SGLT2 inhibitors (Central Illustration). Furthermore, there was significant facility-level variation in the use of SGLT2 inhibitors, which
Conclusions
Our study highlights a very low use of SGLT2 inhibitors in eligible patients with ASCVD, T2DM, and HF with significant facility-level variation. This study serves as a baseline and identifies an opportunity to intensify efforts to improve the utilization of preventive therapies in an extremely high-risk patient phenotype, such as older adults, those other than non-Hispanic White patients, those with lower eGFR, and those with PAD or ischemic cerebrovascular disease. Future studies should
Funding Support and Author Disclosures
This work was supported by a Department of Veterans Affairs (VA) Health Services Research and Development Service Investigator Initiated grants (IIR 16-072, IIR 19-069) and the Houston VA Health Services Research and Development Center for Innovations grant (CIN13-413). Support for VA/Centers for Medicare and Medicaid Services data was provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237
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G. Michael Felker, MD, served as the Guest Associate Editor for this paper. Barry Greenberg, MD, served as the Guest Editor-in-Chief for this paper.
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