Guideline-directed medical therapy (GDMT), including angiotensin receptor-neprilysin inhibitors (ARNIs) and SGLT2 inhibitors, for treating heart failure with reduced ejection fraction (HFrEF) is underused. The marketing of GDMT to general cardiologists is associated with an increased uptake of ARNIs and SGLT2 inhibitors, but not with all pillars of GDMT, according to an analysis of three national physician-level data sets published March 19 in JACC: Heart Failure.

To analyze the association between direct-to-physician marketing meals to provide pharmaceutical and GDMT prescription rates under Medicare Part D, Colette DeJong, MD, et al., linked three Centers for Medicare and Medicaid Services data sets to identify general and advanced HF cardiologists' prescriptions for GDMT from 2019 to 2021, including ARNIs, SGLT2 inhibitors, ACE inhibitors, ARBs, mineralocorticoid receptor antagonists (MRAs) and beta-blockers.

The primary outcome was the total number of filled 30-day prescriptions for each class of GDMT in the year after exposure to marketing meals. They note the primary outcome was determined based on year-end total script counts for each prescriber and could include multiple scripts for the same patient.

Of the 11,277 general and 329 advanced HF cardiologists included in the study, 60% received marketing payments for ARNI and 50% for SGLT2 inhibitors. Of the payments, 90% averaged >$20. Results showed that exposure to ARNI marketing meals in 2020 was associated with a greater prescribing volume of ARNI the following year among general cardiologists, but not advanced HF cardiologists, (1-4 ARNI meals: relative ratio, 1.43; 5-9 ARNI meals: relative ratio, 1.69; and ≥10 ARNI meals: relative ratio, 2.09). The findings for SGLT2 inhibitors were similar, but the association between marketing and prescribing of other drugs such as MRAs in the GDMT pillar was inconsistent. The authors note that marketing of ARNIs or SGLT2 inhibitors did not increase the rate of MRA prescriptions.

"Industry marketing is an effective method for accelerating uptake of underused novel therapies, but is inherently limited to brand-name agents, while effective generics, such as [mineralocorticoid receptor antagonists], remain underused," write the authors. They add that additional strategies are needed to advance uptake of quadruple therapy for HFrEF across the U.S."