Adoption and diffusion of SGLT2 inhibitors among cardiologists in medicare part D, 2019–2023: a provider-level observational study
Abstract
Sodium–glucose cotransporter-2 (SGLT2) inhibitors are guideline-directed therapies for heart failure, yet real-world diffusion into cardiology practice remains incompletely characterized. This study evaluated adoption, prescribing intensity, subspecialty variation, geographic variation, and concentration of SGLT2 inhibitor use among cardiologists in Medicare Part D from 2019 to 2023.
We conducted an observational, provider-level study using Medicare Part D Prescriber–Provider Public Use Files, including all clinicians with a primary specialty designation of cardiology. Primary analyses focused on empagliflozin and dapagliflozin. Outcomes included annual observable adoption (presence of a non-suppressed prescribing record), prescribing intensity among adopters, prescribing concentration (raw and normalized for overall Part D prescribing volume), adoption by cardiology subspecialty, total drug spending, and state-level variation with confidence intervals.
Among approximately 23,000 to 24,000 cardiologists annually, observable adoption increased from 4.5% in 2019 to 56.1% in 2023, with acceleration after 2021. Median prescribing intensity among adopters rose from 23 claims (interquartile range [IQR] 15–43) to 43 claims (IQR 21–90); early adopters prescribed nearly three times the intensity of late adopters after adjustment (incidence rate ratio, 2.96; 95% CI, 2.85–3.08). By 2023, adoption reached 91.6% among cardiologists with a subspecialty designation in advanced heart…
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