Abstract Body (Do not enter title and authors here):
Background: Specific sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) significantly improve outcomes in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD) or heart failure. Contemporary data regarding utilization rates of these medications remain limited.

Hypothesis: Utilization rates of SGLT2i/GLP-1RA remain low, especially among cardiology providers.

Aim: Characterize utilization rates of SGLT2i/GLP-1RA in a large academic medical center (AMC).

Methods: We developed algorithms to query electronic health records from Beth Israel Deaconess Medical Center to identify 18-74 year-old patients with either T2D and ASCVD (cohort 1) or patients with heart failure with reduced or preserved ejection fraction (HFrEF/HFpEF, cohort 2) who qualified for SGLT2i or GLP-1RA therapy between 1/1/21-12/31/22 according to 2020 ACC Expert Consensus Decision Pathway and 2021 ADA Standards of Care guidelines. Positive predictive values (PPV) for each algorithm were calculated following manual review of 150 randomly-selected charts from each cohort. Comparisons were performed using Fisher’s exact test.

Results: We identified 1,022 patients with T2D and ASCVD (PPV 87.9%) who qualified for SGLT2i and/or GLP-1RA therapy and 2,070 patients with HFrEF or HFpEF (PPV 84.7%) who qualified for SGLT2i therapy. In contrast to utilization rates of statins (89.8%), significantly fewer patients with T2D and ASCVD had received a prescription for a SGLT2i (35.9%, P<0.001), GLP-1RA (39.3%, P<0.001), or either medication (54.6%, P<0.001) any time before 12/31/22. Similarly, compared to utilization rates of ACE inhibitors or ARBs (70.4%), significantly fewer patients with HFrEF/HFpEF had received a prescription for a SGLT2i (30.3%, P<0.001). Cardiology providers were the top prescribers for SGLT2i in patients with HFrEF/HFpEF (48.7% of prescriptions). However, cardiology providers prescribed significantly fewer SGLT2i or GLP-1RA for patients with T2D and ASCVD (8.6% of prescriptions) compared to primary care providers (49.4%, P<0.001).

Conclusions: Within a single AMC, utilization rates of SGLT2i and GLP-1RA remain significantly lower than those for other cardioprotective medications. Our data suggest a possible opportunity for cardiology providers to improve utilization of SGLT2i and GLP-1RA. Further study is needed to more broadly characterize these findings.