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GLP-1 RA Initiation in Cardiology
Strategies for Initiating and Managing GLP-1 RAs in Cardiology Practice

Released: October 30, 2023

Expiration: October 30, 2024

Anne Peters
Anne Peters, MD
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Key Takeaways
  • With cardiologists seeing more patients with diabetes and ASCVD than endocrinologists, it is incumbent on cardiologists to integrate the routine prescription of GLP-1RAs into practice
  • Cardiology Guidelines and Clinical Decision Pathway endorse the use of GLP-1 RA for all patients with T2D with or at high risk for ASCVD at the highest level of recommendation for cardiologist prescription/use of 1A
  • Methods for GLP-1 RA integration into cardiology practice begins with a thorough assessment of current barriers to prescribing for each individual clinician and practice setting

Cardiologists often feel that there are barriers to initiating medications that have historically been considered outside of their realm. This includes medications such as GLP-1 receptor agonists (RAs) that were initially developed for the treatment of hyperglycemia but as evidence has evolved, are now primarily cardiovascular (CV) medications for persons with T2D with or at high risk of atherosclerotic cardiovascular disease (ASCVD). Data from the community shows that 2 of the largest barriers to cardiologists prescribing GLP-1 RAs are lack of knowledge of GLP-1 RAs mechanism of action, and lack of understanding of patient criteria for eligibility for use. Perhaps the biggest hurdle is accessibility/affordability for patients, including the hindrance of often required prior authorization for clinicians and staff. Hopefully these access issues will improve given the robustness of the evidence base, product-labeled indications, and Guidelines and Society statements aligned with level 1A recommendations. Due to this, it is almost a certainty that broader insurance coverage will have to follow.

Methods for Integrating Novel Agents

How can cardiologists ensure that the prescription and use of GLP-1 RAs are effectively integrated into their practice? The CINEMA program that has been developed at Case Western Reserve University is an integrated and novel approach, where a multidisciplinary team has been assembled. Through this collaborative clinical care program, they have been able to increase the use of GLP-1 RAs 3-fold after just a single clinic visit in their program from the baseline visit to the follow-up visit.

Formal implementation interventions have the potential to modify clinical practice at the provider and clinic level. The COORDINATE trial was a cluster-randomized trial of cardiology practices where clinics were randomized to receive intense education and partnership with cardiology, endocrinology and implementation specialists to perform assessments of clinic-specific barriers to GLP-1 RA use. After these assessments were complete, they collaborated to develop local processes to minimize such burdens. The trial assessed the proportional use of a high-intensity statin; use of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blocker (ARB); and use of a GLP-1 RA and/or an SGLT2 inhibitor, at baseline and after the intervention was complete among participant patients with T2D and ASCVD. When the implementation intervention was compared with usual care, there was a 23.4% absolute increase in the proportion of patients prescribed all 3 groups of therapies, and an odds ratio of 4.4. Comprehensively assessing and systematically addressing barriers of use in individual clinics can markedly improve penetrant use of evidence-based therapies, including but extending well beyond GLP-1 RA use.

In summary, it is important to look within your cardiology clinic practice and identify barriers to routine use of GLP-1 RAs for persons with T2D with or at high-risk for ASCVD, whether the barrier is your own discomfort or whether it is at the system level, so we can make sure the care of cardiology patients is optimized with all therapies available to reduce cardiovascular risk. 

Interested in learning more? Sign up for an upcoming live CME session on GLP-1 RAs and cardiovascular risk reduction or view the recorded online webinar.

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In your practice, how likely are you to prescribe GLP-1 RAs to your patient with ASCVD and diabetes?

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