Neil S Maitra1, Dhruv Mahtta2,3, Sankar Navaneethan4,5, Elizabeth M Vaughan1,6, Ajar Kochar7, Martha Gulati8, Glenn N Levine2,9, Laura A Petersen3,10, Salim S Virani11,12,13,14,15. 1. Division of General Internal Medicine, Baylor College of Medicine, Houston, TX, USA. 2. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 3. Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. 4. Section of Nephrology and Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA. 5. Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. 6. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 7. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA. 8. Section of Cardiology, University of Arizona College of Medicine - Phoenix, Phoenix, AR, USA. 9. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. 10. Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA. 11. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 12. Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. virani@bcm.edu. 13. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 14. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. virani@bcm.edu. 15. Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development, 2002 Holcombe Boulevard, Houston, TX, USA. virani@bcm.edu.
Abstract
PURPOSE OF REVIEW: To review the factors contributing to underutilization of guideline-directed therapies, identify strategies to alleviate these factors, and apply these strategies for effective and timely dissemination of novel cardioprotective glucose-lowering agents. RECENT FINDINGS: Recent analyses demonstrate underutilization of cardioprotective glucose lowering agents despite guideline recommendations for their use. Major contributors to underutilization of guideline-directed therapies include therapeutic inertia, perceptions about side effects, and factors found at the level of the clinicians, patients, and the healthcare system. The recent emergence of several novel therapies, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, for use in cardiovascular disease provides a unique avenue to improve patient outcomes. To effectively utilize novel cardioprotective glucose lowering agents to improve cardiovascular outcomes, clinicians must recognize and learn from prior barriers to application of guideline-directed therapies. Further endeavors are prudent to ensure uptake of novel agents.
PURPOSE OF REVIEW: To review the factors contributing to underutilization of guideline-directed therapies, identify strategies to alleviate these factors, and apply these strategies for effective and timely dissemination of novel cardioprotective glucose-lowering agents. RECENT FINDINGS: Recent analyses demonstrate underutilization of cardioprotective glucose lowering agents despite guideline recommendations for their use. Major contributors to underutilization of guideline-directed therapies include therapeutic inertia, perceptions about side effects, and factors found at the level of the clinicians, patients, and the healthcare system. The recent emergence of several novel therapies, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, for use in cardiovascular disease provides a unique avenue to improve patient outcomes. To effectively utilize novel cardioprotective glucose lowering agents to improve cardiovascular outcomes, clinicians must recognize and learn from prior barriers to application of guideline-directed therapies. Further endeavors are prudent to ensure uptake of novel agents.
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