Abstract P365: Number of Beds and Volume of Patients Correlates With Increased Uptake of Novel Cardiovascular Medications in the Veterans Affairs System

Abstract

Background: Novel therapies such as angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit, but use remains low for heart failure (HF) and coronary artery disease (CAD). Methods: Patients were identified by diagnosis codes for HF, myocardial infarction, or coronary revascularization between 2017-2021 at 114 sites within the Veterans Health Administration (VA). HF and CAD cohorts included 82,376 and 74,210 patients, respectively. Hospital-level data for ARNI, SGLT2i, and GLP-1 RA were assessed for filled outpatient prescriptions at hospital admission, discharge, or within 6 months of discharge. Patient and site-level characteristics were compared by high-, low-, or mixed-level use of novel medications compared with median prescribing. Results: In HF patients, rates of both ARNI and SGLT2i prescription were 20% and 21%, respectively, in 2021. In CAD patients, SGLT2i or GLP-1 RA use was 30% in 2021. Patient characteristics were similar among sites by high-, mixed- and low-level prescribing of novel medication usage. Sites in the "high" group compared with the "low" group of medication utilization had a greater number of patient-years per site (236 patient-years vs 127 patient-years, respectively, p=0.003) and a greater average number of hospital beds (157 vs 81 beds, respectively, p<0.001). Though nearly all sites (95%) had an academic affiliation, a numerically greater proportion of sites in the "high" group of novel medication use had academic affiliation than the "low" group (100% vs 90% with academic affiliation, respectively, p=0.236). Conclusions: In the VA, sites with the highest utilization ARNI, SGLT2i, and GLP-1 RA use for HF and CAD had greater patient volume and number of beds than sites in the lowest-use sites. This may suggest that centers with more experience in treating HF and CAD have a more rapid uptake of novel cardiovascular therapies.