Low utilization of GLP-1RAs and SGLT2i in high-risk cardiovascular patients with diabetes: nationwide insights from myocardial Infarction and stroke survivors

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216224%3A14110%2F25%3A00144760" target="_blank" >RIV/00216224:14110/25:00144760 - isvavai.cz</a>

Výsledek na webu

<a href="https://academic.oup.com/eurheartj/article/46/Supplement_1/ehaf784.3655/8311509" target="_blank" >https://academic.oup.com/eurheartj/article/46/Supplement_1/ehaf784.3655/8311509</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1093/eurheartj/ehaf784.3655" target="_blank" >10.1093/eurheartj/ehaf784.3655</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Low utilization of GLP-1RAs and SGLT2i in high-risk cardiovascular patients with diabetes: nationwide insights from myocardial Infarction and stroke survivors

Popis výsledku v původním jazyce

Background Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular (CV) benefits and are recommended for T2DM patients with atherosclerotic CVD (ASCVD). However, real-world data on their adoption in high-risk populations, particularly myocardial infarction (MI) and stroke survivors, remain limited. Purpose To assess real-world utilization of GLP-1RAs and SGLT2i among T2DM patients with ASCVD focusing on trends, disparities by age, sex, and region from 2015 to 2023. Methods A nationwide cohort study using data from the National Registry of Reimbursed Health Services (2015-2023), covering all reimbursed health services in the Czech Republic. Patients with nonfatal MI (ICD-10: I21, I22) or stroke (I63, I64) and confirmed T2DM were included. Prescriptions were identified at the event or within 12 months post-event. Utilization trends were analyzed, and logistic regression was used to determine predictors of medication use. Results Among 116,218 MI patients (median age:68 years, 33.5% women), 53,128 (46%) had T2DM (median age:71 years, 37% women). Within 12 months post-MI, 2.1% received GLP-1RAs and 10.6% received SGLT2i, with increasing trends from 0.3% (2015) to 4.8% (2023) (GLP-1RAs) and 0.4% (2015) to 34.8% (2023) (SGLT2i). Women were less likely to receive SGLT2i (aOR: 0.70 [95%CI:0.65-0.74]), while no significant difference was observed for GLP-1RAs (aOR:0.98 [95%CI:0.86-1.12]). Older patients (&gt;70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27-0.36]) and SGLT2i (aOR:0.53 [95%CI:0.50-0.56]). Prescription rates were highest in Prague (3.1% GLP-1RAs; 13.5% SGLT2i) and lowest in the Moravian-Silesian Region (1.4% GLP-1RAs; 8.8% SGLT2i). Among 164,729 stroke patients (median age:73 years, 49% women), 78,562 (48%) had T2DM (median age:75 years, 50% women). Within 12 months post-stroke, 1.2% received GLP-1RAs and 3.7% received SGLT2i, with increasing trends from 0.2% (2015) to 2.8% (2023) (GLP-1RAs) and 0.1% (2015) to 10.4% (2023) (SGLT2i). Women were less likely to receive GLP-1RAs (aOR:0.82 [95%CI:0.72-0.95]) and SGLT2i (aOR:0.57 [95%CI:0.52-0.62]). Older patients (&gt;70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27-0.36]) and SGLT2i (aOR:0.40 [95%CI:0.37-0.44]). Regional disparities were notable, with prescription rates varying from 0.8-2.1% (GLP-1RAs) and 2.4-5.2% (SGLT2i). Conclusions Prescribing rates for GLP-1RAs and SGLT2i have increased over the past eight years but remain low, even among MI and stroke survivors. Women, older patients, and those in lower-income regions are significantly less likely to receive these therapies. Targeted interventions are needed to improve secondary prevention in high-risk diabetic populations and to address these disparities.

Název v anglickém jazyce

Low utilization of GLP-1RAs and SGLT2i in high-risk cardiovascular patients with diabetes: nationwide insights from myocardial Infarction and stroke survivors

Popis výsledku anglicky

Background Cardiovascular disease (CVD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular (CV) benefits and are recommended for T2DM patients with atherosclerotic CVD (ASCVD). However, real-world data on their adoption in high-risk populations, particularly myocardial infarction (MI) and stroke survivors, remain limited. Purpose To assess real-world utilization of GLP-1RAs and SGLT2i among T2DM patients with ASCVD focusing on trends, disparities by age, sex, and region from 2015 to 2023. Methods A nationwide cohort study using data from the National Registry of Reimbursed Health Services (2015-2023), covering all reimbursed health services in the Czech Republic. Patients with nonfatal MI (ICD-10: I21, I22) or stroke (I63, I64) and confirmed T2DM were included. Prescriptions were identified at the event or within 12 months post-event. Utilization trends were analyzed, and logistic regression was used to determine predictors of medication use. Results Among 116,218 MI patients (median age:68 years, 33.5% women), 53,128 (46%) had T2DM (median age:71 years, 37% women). Within 12 months post-MI, 2.1% received GLP-1RAs and 10.6% received SGLT2i, with increasing trends from 0.3% (2015) to 4.8% (2023) (GLP-1RAs) and 0.4% (2015) to 34.8% (2023) (SGLT2i). Women were less likely to receive SGLT2i (aOR: 0.70 [95%CI:0.65-0.74]), while no significant difference was observed for GLP-1RAs (aOR:0.98 [95%CI:0.86-1.12]). Older patients (&gt;70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27-0.36]) and SGLT2i (aOR:0.53 [95%CI:0.50-0.56]). Prescription rates were highest in Prague (3.1% GLP-1RAs; 13.5% SGLT2i) and lowest in the Moravian-Silesian Region (1.4% GLP-1RAs; 8.8% SGLT2i). Among 164,729 stroke patients (median age:73 years, 49% women), 78,562 (48%) had T2DM (median age:75 years, 50% women). Within 12 months post-stroke, 1.2% received GLP-1RAs and 3.7% received SGLT2i, with increasing trends from 0.2% (2015) to 2.8% (2023) (GLP-1RAs) and 0.1% (2015) to 10.4% (2023) (SGLT2i). Women were less likely to receive GLP-1RAs (aOR:0.82 [95%CI:0.72-0.95]) and SGLT2i (aOR:0.57 [95%CI:0.52-0.62]). Older patients (&gt;70 years) had lower odds of receiving GLP-1RAs (aOR:0.31 [95%CI:0.27-0.36]) and SGLT2i (aOR:0.40 [95%CI:0.37-0.44]). Regional disparities were notable, with prescription rates varying from 0.8-2.1% (GLP-1RAs) and 2.4-5.2% (SGLT2i). Conclusions Prescribing rates for GLP-1RAs and SGLT2i have increased over the past eight years but remain low, even among MI and stroke survivors. Women, older patients, and those in lower-income regions are significantly less likely to receive these therapies. Targeted interventions are needed to improve secondary prevention in high-risk diabetic populations and to address these disparities.

Druh

O - Ostatní výsledky

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

<a href="/cs/project/NW24-09-00215" target="_blank" >NW24-09-00215: Analýza velkých dat pro záchranu životů pacientů s akutním infarktem myokardu a cévní mozkovou příhodou v České republice (MISA-BID Myocardial Infarction and Stroke Big Data Analysis)</a><br>

Návaznosti

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů