Cardiovascular disease is the number one killer of people in the United States and around the world. However, doctors often do not prescribe evidence-based medications that could change these statistics.
Neha Pagidipati, MD, associate professor at Duke University School of Medicine, wants to do something about it.
“There are treatments for which there is a large amount of evidence [showing they] It helps people prevent the disease from coming back,” said Pagidipati, a cardiologist who specializes in prevention. “They’re just not being used properly. That has to change at the population level.”
There are three FDA-approved drugs that can reduce the risk of heart attack and stroke, especially as more people have both diabetes and cardiovascular disease (often called cardiometabolic disease). These three drugs treat high blood pressure, high blood sugar, and high cholesterol, which are risk factors for both diabetes and cardiovascular disease.
“These are not fair diseases,” Pajidipati said. “They’re unfairly targeting a patient population that doesn’t have the resources to fight these chronic diseases. That’s part of my motivation, it’s a public health and social justice issue.”
In a recent study called “COORDINATE Diabetes,” Pagidipati and colleagues tested these three drugs in clinics across the country on patients with both diabetes and a particular type of cardiovascular disease called atherosclerosis, or hardening of the arteries. We tested a strategy to encourage doctors to prescribe everything. .
In randomized controlled trials, clinics that followed a multipronged strategy were able to increase the proportion of patients prescribed all three drugs. Half of the participating medical centers received the intervention, and the other half operated as usual.
At the start of the trial, less than 3% of 1,000 patients were prescribed all three drugs. By the end of the trial, that rate had increased to 37.9% in the intervention group.
“This has major implications for what methodologies clinicians can use to improve the way they provide care to this very high-risk population,” Pajdhipati said. “That consideration promotes resilience.”
The intervention was designed to encourage collaboration among professionals who treat patients with diabetes and heart disease. If such adjustments are not made, it may be difficult for cardiologists to prescribe drugs that target blood sugar or for diabetologists to prescribe drugs that target blood pressure. The strategy called for health systems to assemble interdisciplinary teams to identify and remove barriers to coordinated care.
The intervention provided educational materials to both physicians and patients, and provided regular feedback to the clinic on how well the medication was prescribed.
The study was designed to measure increases in prescriptions, not cardiac events such as strokes or heart attacks. However, the researchers found fewer cardiac events (23 events) in the intervention group compared to the business-as-usual group (40 events). Although this difference was not statistically significant, it was encouraging.
Pagidipati hopes the study results will encourage more healthcare institutions to adopt strategies to improve patient health.
At Duke University, Pagidipati is taking coordinated care to a new level. Several years ago, she founded a clinic where patients with advanced cardiometabolic diseases are seen by a multidisciplinary team of experts, including cardiologists, endocrinologists, nephrologists, hepatologists, and pharmacists.
“The goal is to provide coordinated, state-of-the-art, comprehensive preventive care to the highest-risk patients in our health care system,” she said.
Pagidipati’s goal is to improve care not just for patients at Duke University, but for patients everywhere. She is planning a randomized trial to measure the effectiveness of the strategies used in the clinic. If her multidisciplinary team can help patients stay healthy longer, she will spread the word and look for ways to influence the standard of care nationally and internationally.
“At the end of my career, I really want to say that we did something to help people fight cardiometabolic disease, both locally at Duke University and broadly, regionally, nationally, and internationally. ” she said.
Mary Russell Roberson is a freelance writer living in Durham.
Photography by Jafar Farahi.
Main photo: Neha Pagidipati, MD, MPH; Associate Professor at Duke University School of Medicine.
