Marketing Meals Influence Cardiologist Prescribing for HFrEF

TOPLINE:

Industry marketing for angiotensin receptor–neprilysin inhibitors (ARNis) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) targeted at cardiologists was associated with increased prescription of these medications but not with other guideline-directed medical therapies (GDMTs) for heart failure with reduced ejection fraction (HFrEF).

METHODOLOGY:

• Researchers analyzed physician-level datasets from 2019 to 2021 to investigate the association between direct marketing to cardiologists and prescribing rates of each class of GDMTs (ARNis, SGLT2is, mineralocorticoid receptor antagonists [MRAs], beta-blockers, angiotensin-converting enzyme [ACE] inhibitors, and angiotensin receptor blockers [ARBs]).
• They included 11,277 general cardiologists and 329 advanced heart failure cardiologists who prescribed at least 100 filled 30-day scripts for loop diuretic agents annually and did not receive research payments from or have ownership in target companies.
• Prescriptions for ARNis, SGLT2is, MRAs, beta-blockers, ACE inhibitors, ARBs, and loop diuretic agents were identified using Medicare datasets.
• Payments to physicians explicitly associated with GDMT agents were identified, including food and beverages, travel, gifts, speaker fees, and consulting.
• The primary outcome was the total count of filled 30-day prescriptions for each of the GDMT agents in the year following exposure to marketing meals.

TAKEAWAY:

• Approximately 60% of cardiologists received marketing payments for ARNis and 50% of cardiologists received payments for SGLT2is during the study period, primarily for meals costing less than $20.
• Exposure to ARNi marketing meals in 2020 was associated with a dose-dependent increase in the prescribing volume of ARNis in 2021 (relative ratio [RR], 1.43 for 1-4 meals; RR, 1.69 for 5-9 meals; and RR, 2.09 for ≥ 10 meals; all P < .01).
• Similarly, exposure to SGLT2i marketing meals was strongly associated with an increase in the prescribing volume of SGLT2is, with RRs ranging from 1.78 to 9.46 for an increasing number of meals (P < .01).
• Marketing for ARNis or SGLT2is was not consistently associated with an increase in prescriptions for beta-blockers, MRAs, ACE inhibitors, or ARBs.

IN PRACTICE:

“Our results underscore that physician decision-making is a modifiable factor in the timely adoption of GDMT and can inform other efforts to disseminate AHA (American Heart Association)/ACC (American College of Cardiology)/HFSA (Heart Failure Society of America) guidelines,” the authors wrote.

“If ARNi and SGLT2i manufacturers voluntarily pledged to distribute AHA/ACC/HFSA written materials at detailing visits, there may be a greater association between marketing and uptake of guideline-directed quadruple therapy,” they added.

SOURCE:

This study was led by Colette DeJong, MD, from VA Palo Alto Health Care System in Palo Alto, California. It was published online on March 19, 2025, in JACC: Heart Failure.

LIMITATIONS:

Due to the observational nature of this study, findings may be subject to unmeasured confounding. Reverse causation could not be ruled out as industry marketing might target physicians who were already high-volume prescribers. The emergence of SGLT2 inhibitors as therapy for HFrEF during the study period complicated the interpretation of prescribing patterns.

DISCLOSURES:

This study was supported with resources and the use of facilities at the VA Palo Alto Health Care System. DeJong reported receiving support from the American College of Cardiology/Association of Black Cardiologists Merck Research Fellowship Award, among others. DeJong’s spouse reported being an employee of and owning stocks in a healthcare company. Several other authors reported receiving research support and funds from various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.