Trends and site-level variation of novel cardiovascular medication utilization among patients admitted for heart failure or coronary artery disease in the US Veterans Affairs system: 2017-2021

Abstract: OBJECTIVE: We assessed trends in novel cardiovascular medication utilization in US Veterans Affairs (VA) for angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA). METHODS: We retrospectively identified cohorts from 114 VA hospitals with admission for prevalent 1) systolic heart failure (HF, N=82,375) or 2) coronary artery disease and diabetes (CAD+T2D, N=74,209). Site-level data for prevalent filled prescriptions were assessed at hospital admission, discharge, or within 6 months of discharge. Variability among sites was estimated with median odds ratios (mOR), and within-site Pearson correlations of utilization of each medication class were calculated. Site- and patient-level characteristics were compared by high-, mixed-, and low-utilizing sites. RESULTS: ARNI and SGTL2i use for HF increased from <5% to 20% and 21% respectively, while SGTL2i or GLP-1 RA use for CAD+T2D increased from <5% to 30% from 2017-2021. Adjusted mOR and 95% confidence intervals for ARNI, SGTL2i for HF, and SGTL2i or GLP-1 RA for CAD+T2D were 1.73 (1.64-1.91), 1.72 (1.59-1.81), and 1.53 (1.45-1.62), respectively. Utilization of each medication class correlated poorly with use of other novel classes (Pearson <0.38 for all). Higher patient volume, number of beds, and hospital complexity correlated with high-utilizing sites. CONCLUSION: Utilization of novel medications has increased over time but remains suboptimal for US Veterans with HF and CAD+T2D, with substantial site-level heterogeneity despite a universal medication formulary and low out-of-pocket costs for patients. Future work should include further characterization of hospital- and clinician-level practice patterns to serve as targets to increase implementation.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Envisioning a new racial grievance reporting and redress system for the United States military

    Abstract: A better understanding of the weaknesses and strengths of the military’s racial grievance reporting and redress system is needed to understand where and how it can be improved to encourage racial grievance reporting, facilitate timely and effective responses, and promote a more inclusive environment to better support the careers, satisfaction, and well-being of minority service members. The authors identified gaps, ambiguities, inconsistencies, and reported problems in the military racial grievance system through an examination of policies and structures and offered recommendations to improve diversity, equity, and inclusion in the armed forces.