Improving Evidence-Based Cardiometabolic Care, with Neha Pagidipati, MD, MPH

While innovation in cardiovascular, kidney, and metabolic care often centers around emerging therapies, the underuse of established, evidence-based treatments in clinical practice remains a major and under-discussed challenge.

In her session at the 9th Annual Heart in Diabetes Conference in Philadelphia, Pennsylvania, Neha Pagidipati, MD, MPH, an assistant professor of medicine and cardiovascular disease prevention specialist at Duke University School of Medicine, reviewed different barriers to implementing guideline-directed medical therapy as well as facilitators and potential avenues for improvement moving forward.

“It's really exciting to talk about the next new therapy, but I would say it's equally as important to talk about how we get therapies that are already available used appropriately,” Pagidipati explained to HCPLive, highlighting current shortcomings of care for patients with cardiometabolic diseases and potential reasons behind them.

Despite the availability of highly effective, low-cost treatments like high-intensity statins, ACE inhibitors/ARBs, and SGLT2 inhibitors or GLP-1 receptor agonists, Pagidipati notes that their uptake remains alarmingly low. She cites data showing fewer than 2.7% of patients with both diabetes and atherosclerotic cardiovascular disease are on all 3 therapies, stressing the urgency of addressing this implementation gap.

“I think the reasons for lack of evidence-based care are incredibly diverse and complicated, and that's why it's not easy to fix,” Pagidipati said, describing the combination of patient-, clinician, and system-level factors that contribute to this issue.

Looking ahead to what can be done to improve implementation of guideline-directed medical therapy, Pagidipati cites the importance of addressing issues at all levels, emphasizing that all it takes to make a difference locally is for somebody to care. As an example, she references findings from the COORDINATE-Diabetes trial demonstrating better rates of appropriate medical therapy implementation among sites where somebody stepped up as a “champion,” most commonly a nurse, a medical assistant, a pharmacist, or an advanced practice clinician.

Pagidipati also describes national initiatives, including the CardioHealth Alliance and 2 new programs: test to treat, aimed at improving LDL cholesterol testing and follow-up care post–cardiac events, and IRIS CKD, which seeks to boost chronic kidney disease screening and treatment in patients with type 2 diabetes.

“I hope that what people took away is that, yes, we have a problem, we have to recognize that evidence-based therapies are not being used, even when they are inexpensive and widely available. We have to understand why that's happening, importantly on a local level, but also on a health system level,” Pagidipati concluded. “I hope people came away with some amount of optimism that we are trying to address this.”

Editors’ note: Pagidipati has relevant disclosures with Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, CRISPR Therapeutics, Eggland’s Best, Eli Lilly, Esperion, Novartis, Novo Nordisk, Merck, and Miga Health.

Reference

Tannu M, Kaltenbach L, Pagidipati NJ, et al. Effects of an Intervention to Improve Evidence-Based Care for People With Diabetes and Cardiovascular Disease Across Sex, Race, and Ethnicity Subgroups: Insights From the COORDINATE-Diabetes Trial. Circulation. 2024 Jul 16;150(3):180-189. doi:10.1161/CIRCULATIONAHA.124.068962