Patients with atherosclerotic cardiovascular disease (ASCVD) or heart failure with reduced ejection fraction (HFrEF) were more likely to be prescribed PCSK9 inhibitors or an angiotensin receptor–neprilysin inhibitor (ARNi), respectively, if their physicians received industry payments, according to a recent study published in the American Heart Journal. The study also examined patients with nonvalvular atrial fibrillation (AFib) prescribed direct oral anticoagulants (DOACs), but an association was only found in this patient group with physicians who received higher-value payments.

Amarnath R. Annapureddy, MD, MSc, FACC, et al., included 814,800 patients with ASCVD, 16,231 patients with HFrEF and 188,035 patients with nonvalvular AFib from the Veradigm Cardiology Registry (formerly the PINNACLE Registry), to assess the relationship between industry payments to physicians and prescriptions for PCSK9 inhibitors, ARNi and DOACs, respectively. Physicians were stratified by value of payment (<$100, $100–$1,000, >$1,000) for the analysis.

Overall, the rate of patients receiving each of these medications was low: 0.2% of patients with ASCVD, 9% of patients with HFrEF, and 39% of patients with nonvalvular AFib.

The authors found that patients with physicians receiving payments for PCSK9 inhibitors or ARNi had greater odds of being prescribed the corresponding medication (ASCVD cohort odds ratio [OR], 1.35; 95% CI, 1.15–1.57; HFrEF cohort OR, 1.43; 95% CI, 1.19–1.71).

This association was not seen in the nonvalvular AFib cohort (OR, 0.99; 95% CI, 0.95–1.03). However, in all three cohorts, patients with physicians receiving higher-value payments had greater odds of receiving a prescription when compared to physicians receiving lower-value payments.

Annapureddy and colleagues note that their study “builds on recent research showing that industry payments can shape physicians’ prescribing patterns for both medications and devices, though prior studies lacked patient-level data, limiting their ability to account for clinical appropriateness.”

They also propose several potential reasons for the variation in payments and prescribing associations observed, including “differences in marketing strategies, insurance restrictions, drug accessibility, market competition, and physician or patient familiarity with specific medications.”