Publications by Year: 2026

OBJECTIVE: Use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for diabetes or weight management may affect pregnancy outcomes. We sought to estimate the number of U.S. women of reproductive age eligible for GLP-1 RA therapy.

RESEARCH DESIGN AND METHODS: Using 2017-2023 nationally representative survey data, we identified nonpregnant U.S. women aged 18-44 years who met trial-based eligibility criteria for diabetes, weight management, or secondary cardiovascular prevention.

RESULTS: Among 3,218 participants, 1,447 were eligible for GLP-1 RAs, representing 24.6 million U.S. women. Among GLP-1 RA-eligible women, mean BMI was 34.8 kg/m2, 8.3% had diabetes, and 1.9% had prior cardiovascular disease. Eligibility was primarily for weight management (24.1 million), followed by diabetes (2.0 million) and cardiovascular prevention (0.34 million).

CONCLUSIONS: Nearly half of U.S. reproductive-age women are eligible for GLP-1 RAs. Given limited pregnancy safety data and rising cardiometabolic burden in reproductive-age women, research is needed to guide counseling and coverage of preconception GLP-1 RA use.

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BACKGROUND: COVID-19 hospitalization in the pre-Omicron era was associated with an increased risk of major adverse cardiovascular events, but data from the Omicron era are sparse. We examined the risk of death and major adverse cardiovascular events among older adults hospitalized with COVID-19 during the Omicron era compared with the pre-Omicron era and a historical influenza cohort.

METHODS: Retrospective cohort study of Medicare beneficiaries aged ≥65 years hospitalized for COVID-19 in the Omicron era (November 2021-September2022), COVID-19 in the pre-Omicron era (March 2020-November 2021), and influenza (October 2017-September 2018). The primary outcome was a composite of all-cause death and hospitalization for myocardial infarction, ischemic stroke, transient ischemic attack, pulmonary embolism, deep vein thrombosis, heart failure, and cardiac arrest within 1 year of the index admission. We standardized the cohorts using inverse probability weighting.

RESULTS: We included 1 184 182 patients (mean age 79 years; 51% women):361 382 in the Omicron cohort, 731 455 in the pre-Omicron cohort, and 91 345 in the influenza cohort. The risk of the primary outcome in the Omicron cohort was lower than in the pre-Omicron cohort (48.8% versus 49.3%; standardized risk difference, -0.6% [95% CI, -0.8% to -0.3%]) but higher than in the influenza cohort (48.8% versus 33.4%; risk difference, 15.4% [15.1%-15.6%]). Compared with the pre-Omicron cohort, the Omicron cohort had a significantly lower risk of death (34.2% versus 39.7%; risk difference, -5.5% [-5.7% to -5.3%]) but a higher risk of myocardial infarction, stroke or transient ischemic attack, pulmonary embolism, deep vein thrombosis, and heart failure.

CONCLUSIONS: Among older adults hospitalized with COVID-19, the risk of death within 1 year was lower, and the risk of major adverse cardiovascular event was higher in the Omicron era than the pre-Omicron era; however, the risk of either outcome was higher than after influenza hospitalization. These findings underscore the need for effective cardiovascular prevention strategies after a COVID-19 hospitalization.

BACKGROUND: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) reduces mortality rates but remains widely underused. A polypill for HFrEF has been proposed as an implementation strategy to improve GDMT delivery, but little is known about physicians' preferences in the design of HFrEF polypills. Discrete choice experiments (DCEs), in which survey respondents choose among hypothetical products, are a powerful tool in health economics research and can lend insight into key tradeoffs in HFrEF polypill design. However, the process of designing DCEs is complex and often poorly reported.

METHODS: We developed a survey instrument, including a DCE, through a 5-stage mixed-methods process including (1) literature review; (2) physician interviews and surveys; (3) attribute generation; (4) expert review; and (5) pilot testing. We applied a D-efficient design approach using a multinomial logic model to determine the number of choice tasks for the DCE.

RESULTS: We designed a DCE with 4 attributes: HFrEF polypill out-of-pocket cost, inclusion of an angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or sacubitril/valsartan, ancillary support for polypill prescribing, and pharmacy availability. The final survey will be distributed to cardiologists in academic and Veterans Administration medical centers across the United States.

CONCLUSIONS: Through a rigorous multistage design process leveraging mixed methods, we developed a DCE that elicits cardiologists' preferences about HFrEF polypills and key tradeoffs in their design. Results from this DCE study will directly inform future HFrEF polypill cluster-randomized clinical trials.