Systemic inflammation (SI) is a risk factor for atherosclerotic cardiovascular disease (ASCVD) and is most commonly assessed by measuring levels of high-sensitivity C-reactive protein (hsCRP). This study aimed to determine hsCRP testing rates and SI prevalence in patients with ASCVD and in a subset of patients with chronic kidney disease (CKD). This was a retrospective, cross-sectional analysis using US-based data from the Optum® de-identified Electronic Health Record data set (Optum® EHR; 1/1/2017–12/31/2021). hsCRP testing rates and SI prevalence (hsCRP ≥2 to <10 mg/L) were evaluated by calendar year. Demographics, comorbidities, and treatment patterns were compared between patients with ASCVD, ASCVD + CKD, and ASCVD + stage 3/4 CKD, with and without SI. 1,658,476 patients with ASCVD were eligible for study inclusion. Per calendar year, 44.9 %-68.8 % and 14.9 %-18.9 % of patients had any CKD and stage 3/4 CKD, respectively. hsCRP testing was performed in 0.87 %-0.98 % (ASCVD), 0.90 %-1.17 % (ASCVD + CKD), and 0.99 %-1.41 % (ASCVD + stage 3/4 CKD) of patients. SI was present in 37.16 %-38.62 % (ASCVD), 40.61 %-44.44 % (ASCVD + CKD), and 49.44 %-53.92 % (ASCVD + stage 3/4 CKD) of tested patients. Among those with SI, patients with CKD had a greater comorbidity burden than those without. While rates of hsCRP testing were low in patients with ASCVD, the prevalence of SI was high in hsCRP-tested patients with ASCVD, irrespective of CKD presence or severity. Given the low rate of testing, patients with SI may not be identified and treated.

To investigate real-world treatment adherence and persistence in people with type 2 diabetes newly initiating oral semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), or a dipeptidyl peptidase-4 inhibitor (DPP-4i). This retrospective cohort study used the Merative™ MarketScan® Commercial and Medicare databases. Index date was the first fill for the cohort medication. Adherence was defined as proportion of days covered (PDC) over the 12-month post-index period ('adherent' = ≥0.8). Persistence was number of days until discontinuation, based on a 45-day gap. Results were compared between cohorts using inverse probability treatment weighting. Oral semaglutide (n=5485) and DPP-4i (n=4980) cohorts had similar percentages of people who were adherent (PDC ≥0.8; 41.6 % vs. 42.9 %; P = 0.182) and persistent for ≥9 months (45.0 % vs. 46.3 %; P = 0.185). The DPP-4i cohort used significantly more anti-diabetic medication (ADM) classes over the post-index period (mean±SD: 2.6±1.0 vs. 2.9±1.1, P < 0.001), with 23.2 % filling a GLP-1 RA in the post-period. Adherence and persistence were similar between cohorts. However, there are potential benefits to prescribing oral semaglutide over DPP-4is, including reduced need for additional ADM.

AimsTo compare all-cause and Alzheimer's disease (AD)-related healthcare resource utilization (HCRU) by cognitive stage.Methods and MaterialsThis retrospective study analyzed insurance claims data linked to electronic health records (01/01/2015-12/31/2021). Patients with ≥1 cognitive assessment (Mini-Mental State Examination or Montreal Cognitive Assessment) and ≥1 medical or pharmacy claim for an AD diagnosis or AD medications were included. Inverse probability of treatment weighting (IPTW) was used to address potential confounding. All-cause and AD-related HCRU were summarized per patient per year (PPPY) and compared between early AD and advanced AD cohorts (defined according to cognitive scores) using generalized linear regression models; adjusted incidence rate ratios (IRRs), and 95% confidence intervals (CI) were reported.ResultsA total of 193 patients were included (median age: 82 years; 63.2% female), 108 with early AD and 85 with advanced AD, with similar mean follow up. All-cause HCRU, on average, was similar between early AD and advanced AD cohorts (37.4 PPPY and 38.9 encounters PPPY, respectively). For AD-related HCRU, patients with early AD had fewer encounters PPPY, on average, than patients with advanced AD (1.26 and 3.88 encounters, respectively). Following IPTW adjustment, the advanced AD cohort had significantly higher overall AD-related HCRU (IRR: 3.64 [95% CI: 1.96-6.75], p <0.001) and outpatient visits (IRR: 2.76 [95% CI: 1.68-4.54], p <0.001) compared to the early AD cohort.LimitationsThe relatively small sample size of patients with linked claims and cognitive score data limited the ability to assess contribution of all encounter types to HCRU trends, as well as generalizability to the broader AD population.ConclusionsAlthough all-cause HCRU was similar, patients with advanced AD incurred higher AD-related HCRU compared to patients living with early AD. Further research is needed to determine whether interventions earlier in disease progression can mitigate the AD-related healthcare burden for patients with advanced AD.

High-sensitivity C-reactive protein (hsCRP) is a biomarker of systemic inflammation (SI) and its elevated level is considered a risk-enhancing factor for cardiovascular disease in primary prevention. This study aimed to understand opinions of US clinicians using hsCRP testing in the management of patients with atherosclerotic cardiovascular disease (ASCVD) with or without chronic kidney disease (CKD). Clinicians who ordered hsCRP testing with evaluation of patient-level data were surveyed, between June 2023-August 2023. Endpoints included self-identified drivers and barriers to hsCRP testing and assessment of posttest actions following SI recognition. Common factors perceived to prevent hsCRP testing were a lack of evidence showing improvements in patient cardiovascular outcomes after addressing SI in ASCVD and CKD (50%), and lack of proven efficacy of hsCRP testing (33%). Barriers to hsCRP testing included cost, insurance coverage and patient refusal. The most common reason for not considering SI in clinical decision-making was that it would not affect management of ASCVD. After the first hsCRP testing, an average reduction of hsCRP level is observed, but not lower than 2 mg/L. In this limited study sample, perceived limitations of hsCRP testing included insufficient evidence of improved cardiovascular outcomes in patients with ASCVD.

The population-level impact of newer glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatments on patients with type 2 diabetes remains unclear. Therefore, this study investigated the association of newer GLP-1 RAs with population-level diabetes-related outcomes in US adults with type 2 diabetes. This was a noninterventional, retrospective analysis of administrative insurance claims data obtained from Optum's de-identified Clinformatics® Data Mart Database between January 2004 and December 2022. Individual patient data were aggregated into monthly time series at the population level. Associations between the proportion of patients on newer GLP-1 RAs of interest (dulaglutide, once-weekly or oral semaglutide, and tirzepatide) and average hemoglobin A1c (HbA1c), HbA1c <7.0%, and HbA1c <8.0% were assessed using time series regressions. Time-based trends in population-level outcomes were assessed using interrupted time series analyses. All analyses were adjusted for potential confounders. Time series regression analyses demonstrated that a higher proportion of patients taking newer GLP-1 RAs was associated with a lower average HbA1c and a higher proportion of patients with HbA1c <7.0% (after 5 months of treatment) and <8.0% (after 2 months of treatment). Results from the interrupted time series analyses demonstrated that population-level glycemic control has been improving since the first newer GLP-1 RA (dulaglutide) was approved. This trend has persisted, even following the COVID-19 emergency declaration. A higher percentage of patients receiving newer GLP-1 RAs was associated with significantly improved population-level glycemic control. The newer GLP-1 RA period displayed improved population-level glycemic control vs the older GLP-1 RA period.

Acute myocardial infarction (AMI), a leading cause of death in the US, is associated with significant clinical and economic burden. Systemic inflammation is a risk factor for worse cardiovascular outcomes, but the role of systemic inflammation in patients with AMI is not well established. To evaluate clinical, health care resource utilization (HCRU), and economic outcomes in patients with type 1 AMI, and explore results based on systemic inflammation status. Data from the Premier Healthcare Database were retrospectively analyzed, including adults with ≥1 inpatient hospitalization for type 1 AMI (using ICD-10-CM codes) from January 1, 2017, to August 31, 2023. Data were analyzed at index and within 30 and 90 days after index discharge. Demographics, clinical and HCRU outcomes, and costs were described for all patients with AMI and compared between those with and without evidence of systemic inflammation. Inflammation status was based on C-reactive protein (CRP) or high-sensitivity C-reactive protein (hsCRP) levels, such that patients with CRP/hsCRP between 2 and 10 mg/L were considered to have evidence of systemic inflammation. Patients with levels <2 mg/L or without CRP/hsCRP test results were considered to have no evidence of systemic inflammation. CRP/hsCRP test results were available in a limited number of patients. Among patients with AMI (N = 1,078,572), in-hospital mortality was 7.6 % during index hospitalization. The mean index length of stay was 5 days, and average cost of care was $23,648. Readmission rates were 7.9 % and 12.9 % within 30 and 90 days after discharge, respectively. Patients with evidence of systemic inflammation (n = 1673) had higher mortality and longer index stays as well as increased readmission rates compared with patients without evidence of systemic inflammation (n = 1,076,899) (all, P < 0.01). Patients experiencing AMI, and especially those with evidence of systemic inflammation, experience persistently high risk of mortality, morbidity, recurrence, and large economic burdens. Greater attention is needed to optimize the care of this at-risk population.