Direct marketing to cardiologists increases uptake of some, but not all, heart failure drugs
Industry marketing may influence general cardiologists to prescribe some heart failure medications more often to their patients, according to a new study published in JACC: Heart Failure.[1] This trend, however, is not consistently seen across the board.
“A cornerstone of direct-to-physician marketing is providing inexpensive free meals at a prescriber’s clinic, during which drug representatives share pharmaceutical information with prescribers and staff,” wrote first author Colette DeJong, MD, a cardiologist with Stanford Medicine and the VA Palo Alto Health Care System, and colleagues. “Direct-to-physician marketing has been associated with physician prescribing in diverse areas such as antidepressants, insulin, and antihypertensives … Although it is appropriate to scrutinize industry marketing for its ties to prescribing of low-value drugs, marketing may play a role in accelerating delivery of impactful, underused therapies, such as guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF).”
DeJong et al. explored years of U.S. Centers of Medicare and Medicaid Services data, focusing on prescriptions for any angiotensin receptor-neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitor (SGLT2i), mineralocorticoid receptor antagonists (MRA), beta-blocker, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) or loop diuretic agents written by a general or advanced heart failure (AHF) cardiologist from 2019 to 2021. All prescriptions were normalized to 30-day supplies.
The group did note that two popular SGLT2i options became available during their analysis. This included dapagliflozin, which gained U.S. Food and Drug Administration (FDA) approval for treating HFrEF in 2020, and empagliflozin, which gained FDA approval for treating HFrEF in 2021.
The analysis included data from more than 11,000 cardiologists. While 97% were general cardiologists, the remaining 3% were AHF cardiologists. A significant majority of general cardiologists (86.7%) and AHF cardiologists (73.6%) were men.
Overall, receiving a free meal as part of industry marketing campaign was associated with a notable increase in both ARNI and SGLT2i prescriptions for general cardiologists, but not AHF cardiologists. Marketing efforts focused on the potential benefits of ARNI and SGLT2i prescriptions did not appear to impact prescription habits for MRAs, but ARNI marketing did slightly increase prescriptions for beta-blockers, ACEIs and ARBs.
“The association between marketing and prescribing was significant for general cardiologists, but not AHF cardiologists,” the authors wrote. “This is consistent with prior research in which marketing was more impactful among generalists than specialists. Compared with general cardiologists, AHF specialists may be more likely to have familiarity with recently approved HFrEF agents, and may have more avenues outside of industry detailing for building comfort with novel HFrEF agents and incorporating them into day-to-day practice. Our findings suggest that brief, repeated educational encounters in the workplace are an effective strategy for reaching busy practicing physicians.”
Click here to read the full study in JACC: Advances, an American College of Cardiology journal.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.