Multifaceted intervention improves prescription of therapies in T2DM and ASCVD

ACC.23 In the COORDINATE-Diabetes trial was investigated whether a multifaceted intervention can improve prescription of 3 groups of evidence-based therapies in patients with T2DM and ASCVD.

Presented at the ACC.23/WCC by: Neha Pagidipati, MD - Durham, NC, USA

Introduction and methods

A recent study showed that high-intensity statins, ACEi/ARBs and SGLT2i or GLP-1RAs are underused in clinical practice, despite proven benefits in patients with T2DM and ASCVD, and recommendations for these agents in guidelines and by medical societies. In a recent study in the US, 2.7% of patients were on all 3 groups and 37.4% were on none (Nelson et al., JAHA 2021,10(2):e016835).

The COORDINATE-Diabetes trial was an RCT with randomization at the clinic level. 43 Cardiology clinics in the US enrolling patients with T2DM and ASCVD were randomized to a multifaceted intervention or usual care. The intervention was multifaceted and based on 3 core principles: assessment of local practices and barriers, development of strategies to overcome those barrier and audit and feedback. A team of the COORDINATE-center facilitated the intervention at the local sites.

The primary outcome was the proportion of patients who had prescription of all 3 groups of recommended therapies, which included high-intensity statin, ACEi or ARB and a SGLT2i or GLP-1RA, at 12 months follow-up.

Main results

• At 12 months, 37.9% of patients in the intervention group were prescribed all 3 therapies vs. 14.5% in the usual care group (absolute difference of 23.4%, adjusted OR 4.38, 95%CI: 2.49-7.71, P<0.001).

Conclusion

This RCT showed that a multifaceted intervention is effective in increasing the prescription of evidence-based therapies in patients with T2DM and ASCVD. The presenter - Neha Pagidipati- noted that the next step is to scale this intervention across cardiology practices to improve the quality of care for patients with T2DM and ASCVD.

- Our reporting is based on the information provided at the ACC.23/WCC -

The findings of this study were simultaneously published in JAMADetails of the intervention can be found online