Expert cardiologists discuss the economic and QoL metrics that would be useful to quantify the potential impact of SGLT2 inhibitors in the HF space.
Neil Minkoff, MD: It sounds like you were an early adopter, from a payer point of view, of the use of SGLT2 [sodium-glucose cotransporter-2] inhibition in heart failure without diabetes. How will you look at the impact of making that decision? What are the patient improvements, health care utilization measures, etc, that you’ll be looking at to say, “Yes, I feel good about the decision we made” or, “I feel like it’s having the impact we wanted it to make?”
Jaime Murillo, MD: To put it in perspective, think about the cost of a single hospitalization when you prevent readmissions. As I said before, we’re not there yet, but we talk about it by weighing the quality of life. Those patients will have a better quality of life if they stay out of the hospital. They’ll be able to walk around, breathe better, and be more functional. But from the economic standpoint and the tools that we have, the readmission alone makes a big difference in terms of making those decisions going forward.
Neil Minkoff, MD: OK. Dr Nissen, I didn’t want to cut you off.
Steven Nissen, MD: No, thank you. First of all, I don’t want us to entirely blame the payer community for the problem.
Jaime Murillo, MD: Thank you.
Neil Minkoff, MD: We’re not going to let you, so it’s OK.
Steven Nissen, MD: There’s this phenomenon and we need to talk about it frankly. That is sometimes called clinical inertia, and it’s powerful. People train, they learn a certain way of doing things, they seem to have some success with it, they go with the flow, and new science comes along. That’s why programs like this are really important. We all have a role to play, both the payers and the people working in the clinical community, to educate people about this. I lived through this during the development of the statins, where years after we had evidence of huge morbidity and mortality benefit for statins, we weren’t getting people on statins. They were not getting on statins at the rates that they should have been. It wasn’t necessarily the payers; it was us. We need to find effective tools for dealing with clinical inertia. Some of it is incentives, and you mentioned this, Nihar. That’s a very important point that you made. But I’d be interested in comments from anyone about how we get people to get with the program and actually do this. We’ve really not been as effective as I would like.
Nihar Desai, MD, MPH: Your call to action is incredibly important. That starts with clinicians and providers. We need to educate ourselves, but also to engage with each other, talk to colleagues, and have forums like this one. As you said, it’s important for disseminating ideas and having some back and forth. But then we also need to reimagine what a high-value, high-reliability, learning health care system could and should do for our patients.
This example of SGLT2 inhibitors in heart failure, cardiovascular disease, and diabetes has exposed many of the things that have plagued our system for too long. I hope that we take this as an opportunity to commit ourselves to educating one another, engaging with one another, and thinking anew about what a patient’s care and their care experience should be like.