Provider-Level and Specialty Variation in ARNI and SGLT2i Use After Heart Failure Hospitalization

Provider-level prescribing after HFrEF hospitalization shows large variation in ARNI (adjusted mOR 1.45) and SGLT2i (mOR 1.46) use among 7,946 VA providers.

• Why it matters: ARNI and SGLT2i are incompletely used after heart failure hospitalization, but it is unclear whether gaps reflect differences between specialties or between individual clinicians.
• What they did: In a retrospective VA cohort of providers seeing patients within 6 months of HFrEF hospitalization from 2017–2023, multilevel logistic regression estimated adjusted median odds ratios and provider-level rate ratios by percentile, including effects of specialty, provider type, provider sex, and pharmacy visits.
• The result: Within every specialty, provider use ranged from near-zero to near-100%, with 95th-percentile relative rates up to 1.8–3.2 versus the specialty median, and pharmacist visits were linked to higher ARNI and SGLT2i use.

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