Abhinav Sharma1, Haya Aziz, Subodh Verma, Beth L Abramson, Richard Choi, Grace L Chua, Kim A Connelly, George Honos, G B John Mancini, Sarah A Ramer, Elizabeth Swiggum, Hwee Teoh, Shelley Zieroth, Lawrence A Leiter. 1. Division of Cardiology, McGill University Health Centre, Montréal, Québec Division of Cardiac Surgery, St Michael's Hospital Departments of Surgery, and Pharmacology and Toxicology, University of Toronto Division of Cardiology, St. Michael's Hospital Department of Medicine, University of Toronto Division of Cardiology, St Joseph's Health Centre, Toronto Division of Cardiology, Mackenzie Health, Richmond Hill Departments of Medicine, and Physiology, University of Toronto, Toronto, Ontario Division of Cardiology, Centre hospitalier de l'Université de Montréal, Montréal, Québec Division of Cardiology, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia Division of Cardiology, QEII Health Sciences Centre Halifax Department of Medicine, Dalhousie University, Halifax, Nova Scotia Division of Cardiology, Royal Jubilee Hospital Department of Medicine, University of British Columbia, Vancouver, British Columbia, Victoria Divisions of Cardiac Surgery, and Endocrinology and Metabolism, St Michael's Hospital, Toronto, Ontario Section of Cardiology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba Division of Endocrinology and Metabolism, St Michael's Hospital Departments of Medicine and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Abstract
PURPOSE OF REVIEW: Antihyperglycemic therapies including sodium glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been demonstrated to confer significant cardiovascular benefit and reduce future events in patients with type 2 diabetes mellitus (T2DM). However, despite positive data from cardiovascular outcome trials, these therapies remain underutilized in a large proportion of patients who have clinical indications and meet coverage guidelines for their initiation. One of the causes of the observed gap between scientific evidence and clinical cardiology practice is therapeutic hesitancy (otherwise known as therapeutic inertia). The purpose of this review is to discuss the contributors to therapeutic hesitancy in the implementation of these evidence-based therapies and, more importantly, provide pragmatic solutions to address these barriers. RECENT FINDINGS: Recent studies have demonstrated that clinicians may not initiate cardiovascular protective therapies due to a reluctance to overstep perceived interdisciplinary boundaries, concerns about causing harm due to medication side effects, and a sense of unfamiliarity with the optimal choice of therapy amidst a rapidly evolving landscape of T2DM therapies. SUMMARY: Herein, we describe a multifaceted approach aimed at creating a 'permission to prescribe' culture, developing integrated multidisciplinary models of care, enhancing trainees' experiences in cardiovascular disease prevention, and utilizing technology to motivate change. Taken together, these interventions should increase the implementation of evidence-based therapies and improve the quality of life and cardiovascular outcomes of individuals with T2DM.
PURPOSE OF REVIEW: Antihyperglycemic therapies including sodium glucose contransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been demonstrated to confer significant cardiovascular benefit and reduce future events in patients with type 2 diabetes mellitus (T2DM). However, despite positive data from cardiovascular outcome trials, these therapies remain underutilized in a large proportion of patients who have clinical indications and meet coverage guidelines for their initiation. One of the causes of the observed gap between scientific evidence and clinical cardiology practice is therapeutic hesitancy (otherwise known as therapeutic inertia). The purpose of this review is to discuss the contributors to therapeutic hesitancy in the implementation of these evidence-based therapies and, more importantly, provide pragmatic solutions to address these barriers. RECENT FINDINGS: Recent studies have demonstrated that clinicians may not initiate cardiovascular protective therapies due to a reluctance to overstep perceived interdisciplinary boundaries, concerns about causing harm due to medication side effects, and a sense of unfamiliarity with the optimal choice of therapy amidst a rapidly evolving landscape of T2DM therapies. SUMMARY: Herein, we describe a multifaceted approach aimed at creating a 'permission to prescribe' culture, developing integrated multidisciplinary models of care, enhancing trainees' experiences in cardiovascular disease prevention, and utilizing technology to motivate change. Taken together, these interventions should increase the implementation of evidence-based therapies and improve the quality of life and cardiovascular outcomes of individuals with T2DM.
Authors: Jonathan Hanna; Arash A Nargesi; Utibe R Essien; Veer Sangha; Zhenqiu Lin; Harlan M Krumholz; Rohan Khera Journal: Am J Prev Cardiol Date: 2022-08-02