Evidence map›Paper›PMID 40117391›Full record

ArticleJACC. Heart failure2025

Direct-to-Physician Marketing and Uptake of Optimal Medical Therapy for Heart Failure With Reduced Ejection Fraction.

Colette DeJong, Kosuke Inoue, Matthew S Durstenfeld, Anubha Agarwal, Justin C Chen, Chien-Wen Tseng, R Adams Dudley, Priscilla Y Hsue, Dhruv S Kazi

Abstract read
In one paragraph

Article in JACC. Heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Colette DeJongCardiology Section, VA Palo Alto Health Care System, Palo Alto, California, USA; Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, USA.
Kosuke InoueDepartment of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Hakubi Center, Kyoto University, Kyoto, Japan; Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Matthew S DurstenfeldDivision of Cardiology at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California-San Francisco (UCSF), San Francisco, California, USA.
Anubha AgarwalDivision of Cardiology and Global Health Center, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.
Justin C ChenDivision of Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA.
Chien-Wen TsengDepartment of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA; Pacific Health Research and Education Institute, Honolulu, Hawaii, USA.
R Adams DudleyCenter for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA.
Priscilla Y HsueDivision of Cardiology, University of California-Los Angeles, Los Angeles, California, USA.
Dhruv S KaziRichard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: dkazi@bidmc.harvard.edu.

Funding

Heart Failure Polypill in India: A Late-Stage Implementation StrategyR00HL157687 · NHLBI · WASHINGTON UNIVERSITY · PI ANUBHA AGARWAL · 2025 to 2026
$607k
Low Cardiorespiratory Fitness and Chronotropic Incompetence inHIV: Risk Factors, Cardiovascular Implications, and Exercise Training as TreatmentK23HL172699 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Matthew Durstenfeld · 2024 to 2026
$593k
Heart Failure Polypill in India: A Late-Stage Implementation StrategyK99HL157687 · NHLBI · WASHINGTON UNIVERSITY · PI AGARWAL, ANUBHA · 2022 to 2023
$351k
NHLBI NIH HHS K23 HL172699NHLBI NIH HHS K99 HL157687NHLBI NIH HHS R00 HL157687
6 · The paper itself

Abstract

backgroundGuideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction remains underused. The role of direct-to-physician marketing in accelerating uptake of GDMT is unknown.

objectivesThe authors investigated the association between industry marketing meals and GDMT prescribing rates under Medicare Part D.

methodsThe authors linked Medicare data sets to identify general and advanced heart failure (AHF) cardiologists' prescriptions for angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists (MRAs), and beta-blockers from 2019 to 2021. Using negative binomial regression analyses, they examined the association between marketing meals and prescribing rates of marketed and un-marketed classes of GDMT.

resultsOf 11,277 general and 329 AHF cardiologists, 60% received marketing payments for ARNI and 50% for SGLT2i from 2019 to 2021. Among general cardiologists, but not AHF cardiologists, exposure to ARNI marketing meals in 2020 was associated with a greater prescribing volume of ARNI in 2021 (1-4 ARNI meals; relative ratio: 1.43 [95% CI: 1.34-1.53]; 5-9 ARNI meals; relative ratio: 1.69 [95% CI: 1.48-1.93]; ≥10 ARNI meals; relative ratio: 2.09 [95% CI: 1.80-2.43]). Findings were similar for SGLT2i. The association between marketing and prescribing of other pillars of GDMT was inconsistent across drug classes. Neither ARNI nor SGLT2i marketing was consistently associated with increased prescribing of MRAs.

conclusionsIndustry marketing to general cardiologists is associated with increased uptake of ARNIs and SGLT2is, but not with increased uptake of all pillars of GDMT. Improvements in comprehensive therapy for heart failure will require other mechanisms to accelerate uptake of MRAs and beta-blockers, as well as ARNIs and SGLT2is once multiple generic formulations become available in the United States.

Indexed as

Heart FailureMarketingPractice Patterns, Physicians'Stroke VolumeAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCardiologistsFemaleHumansMaleMedicare Part DMineralocorticoid Receptor AntagonistsSodium-Glucose Transporter 2 InhibitorsUnited StatesAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsMineralocorticoid Receptor AntagonistsSodium-Glucose Transporter 2 InhibitorsGDMTHFrEFmarketing

Identifiers

PMID40117391
PMCPMC12516336

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.