Internal Medicine

GLP-1 receptor agonists vs DPP-4 and SGLT2 inhibitors for heart failure hospitalization in type 2 diabetes

In this Swedish target trial emulation of 63,083 adults with type 2 diabetes, 3-year heart failure hospitalization risk was lower with GLP-1 receptor agonists versus DPP-4 inhibitors (3.4% vs 4.3%). The weighted hazard ratio for heart failure hospitalization comparing GLP-1 receptor agonists with DPP-4 inhibitors was 0.77 (95% CI, 0.66-0.91). Compared with SGLT2 inhibitors, GLP-1 receptor agonists had similar 3-year heart failure hospitalization risk (3.6% vs 3.3%; HR 1.02, 95% CI, 0.85-1.18). Benefits versus DPP-4 inhibitors were greatest in patients with higher predicted heart failure risk and consistent for liraglutide and semaglutide. 1

High telehealth primary care use modestly shifts care without raising hospitalizations or spending

This national 20% Medicare cohort compared beneficiaries attributed to practices in the highest versus lowest quartile of early-pandemic telehealth evaluation and management use. High-telehealth practices had fewer in-person visits (-0.86 visits per patient-year; 95% CI, -0.94 to -0.78) but slightly more total primary care visits (+0.10; 95% CI, 0.03-0.18). Patients at high-telehealth practices had modestly higher total and preventable ED visits, but no significant differences in hospitalizations or ambulatory care-sensitive admissions. Overall healthcare spending, including inpatient and outpatient costs, did not differ significantly between high- and low-telehealth practices. 2

Virtual annual visits reduce test ordering and completion, especially for point-of-care labs

In 22,547 matched annual visits across 87 primary care practices, both high- and low-value tests were ordered and completed less often at virtual versus in-person visits. Relative to in-person care, high-value tests were 14.3% less likely to be ordered and 13.1% less likely to be completed after virtual visits. Low-value tests showed larger reductions with virtual visits, with ordering 19.3% lower and completion 17.3% lower than in-person visits. Point-of-care laboratory tests had particularly large declines in ordering (-18.5%) and completion (-16.3%) with virtual visits compared with smaller drops for scheduled tests. 3

Cumulative anticholinergic burden strongly associated with incident cardiovascular disease

This population-based cohort followed 508,273 Stockholm residents aged 45 years or older without major cardiovascular disease for a median of 14 years. Using time-updated exposure, annual anticholinergic use of 1-89, 90-364, and ≥365 defined daily doses was associated with hazard ratios of 1.16, 1.31, and 1.71, respectively, for cardiovascular events. In the highest exposure group, heart failure risk was markedly elevated (HR 2.70, 95% CI, 2.57-2.84) and arrhythmia risk was also increased (HR 2.17, 95% CI, 2.08-2.27). Myocardial infarction, cerebrovascular disease, artery disease, and venous thromboembolism risks were similarly higher at greater anticholinergic exposure, with a clear dose-response pattern. 4