Abstract
BACKGROUND: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction remains underused. The role of direct-to-physician marketing in accelerating uptake of GDMT is unknown.
OBJECTIVES: The authors investigated the association between industry marketing meals and GDMT prescribing rates under Medicare Part D.
METHODS: The authors linked Medicare data sets to identify general and advanced heart failure (AHF) cardiologists' prescriptions for angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists (MRAs), and beta-blockers from 2019 to 2021. Using negative binomial regression analyses, they examined the association between marketing meals and prescribing rates of marketed and un-marketed classes of GDMT.
RESULTS: Of 11,277 general and 329 AHF cardiologists, 60% received marketing payments for ARNI and 50% for SGLT2i from 2019 to 2021. Among general cardiologists, but not AHF cardiologists, exposure to ARNI marketing meals in 2020 was associated with a greater prescribing volume of ARNI in 2021 (1-4 ARNI meals; relative ratio: 1.43 [95% CI: 1.34-1.53]; 5-9 ARNI meals; relative ratio: 1.69 [95% CI: 1.48-1.93]; ≥10 ARNI meals; relative ratio: 2.09 [95% CI: 1.80-2.43]). Findings were similar for SGLT2i. The association between marketing and prescribing of other pillars of GDMT was inconsistent across drug classes. Neither ARNI nor SGLT2i marketing was consistently associated with increased prescribing of MRAs.
CONCLUSIONS: Industry marketing to general cardiologists is associated with increased uptake of ARNIs and SGLT2is, but not with increased uptake of all pillars of GDMT. Improvements in comprehensive therapy for heart failure will require other mechanisms to accelerate uptake of MRAs and beta-blockers, as well as ARNIs and SGLT2is once multiple generic formulations become available in the United States.