Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA, 329(15), 1261. https://doi.org/10.1001/jama.2023.2854 Dr. Neha Pagidipati et al.
Points
- Many adults with type 2 diabetes and atherosclerotic cardiovascular disease do not receive evidence-based therapies to reduce their risk.
- A coordinated, multifaceted intervention that included assessing local barriers, developing care pathways, educating clinicians, and reporting data back to clinics was more effective than usual care in increasing the prescription of recommended therapies.
- The intervention was associated with a 23.4% difference in the proportion of participants prescribed all three recommended therapies. The intervention group was more likely to be prescribed each therapy.
- The intervention did not lead to significant changes in atherosclerotic cardiovascular disease risk factors or the composite outcome of all-cause death or hospitalization for specific cardiovascular events.
- The study highlights the potential benefits of coordinated efforts to improve the use of evidence-based therapies in clinical practice for patients with type 2 diabetes and atherosclerotic cardiovascular disease.
Summary
The study was a cluster randomized clinical trial conducted across 43 US cardiology clinics from July 2019 through May 2022, with a follow-up period through December 2022. The trial enrolled 1049 participants, of which 459 were assigned to the intervention group and 590 to the usual care group. The median age of participants was 70 years, and 32.2% were women, 16.5% were Black, and 8.6% were Hispanic.
The primary outcome of the study was the proportion of participants prescribed all three groups of recommended therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]) at 6 to 12 months after enrollment. The study found that participants in the intervention group were more likely to be prescribed all three therapies (37.9%) than those in the usual care group (14.5%), with an adjusted odds ratio of 4.38 (95% CI, 2.49 to 7.71; P < .001).
In addition, the study found that the intervention group was more likely to be prescribed each of the three therapies individually than the usual care group. Specifically, the intervention group had a more significant increase in prescription rates for high-intensity statins (from 66.5% to 70.7%), ACEIs or ARBs (from 75.1% to 81.4%), and SGLT2 inhibitors and/or GLP-1RAs (from 12.3% to 60.4%) than the usual care group. However, the intervention was not associated with significant changes in atherosclerotic cardiovascular disease risk factors or the composite secondary outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2802167
References Pagidipati, N. J., Nelson, A. J., Kaltenbach, L. A., Leyva, M., McGuire, D. K., Pop-Busui, R., Cavender, M. A., Aroda, V. R., Magwire, M. L., Richardson, C. R., Lingvay, I., Kirk, J. K., Al-Khalidi, H. R., Webb, L., Gaynor, T., Pak, J., Senyucel, C., Lopes, R. D., Green, J. B., … Bruemmer, D. (2023). Coordinated care to optimize cardiovascular preventive therapies in type 2 diabetes: A randomized clinical trial. JAMA, 329(15), 1261. https://doi.org/10.1001/jama.2023.2854
