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Background <p>Stroke is a leading cause of death and disability. Trials suggest that sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-receptor-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk in selected populations.</p> Objectives <p>To describe facility-level use of SGLT-2i/GLP-1 RAs among patients hospitalized with ischemic stroke in the US Department of Veterans Affairs (VA) hospitals and to examine facility determinants of prescribing.</p> Methods <p>We performed a retrospective trend analysis across 88 VA facilities (fiscal years 2020–2023). Prescribing was ascertained from VA pharmacy data; the outcome was the proportion of ischemic-stroke admissions receiving an SGLT-2i or GLP-1 RA. Facility-level binomial logistic models evaluated associations with VA hospital complexity (1, high; 2, low complexity), rural-serving, and volume.</p> Results <p>Among 17,093 admissions, facility-level prescribing ranged from 13.2% to 38.3%. Overall use increased from 21.8% (2020) to 30.1% (2023; <i>P</i> &lt; 0.001), driven largely by patients with diabetes (38.9% to 51.5%); rates also increased in overweight patients (27.1% to 34.3%) but remained low in those without diabetes or overweight (3.4% to 7.0%, <i>P</i> = 0.010). Across years, 45.7% of patients with diabetes received therapy versus 7.8% without diabetes. In adjusted analyses, prescribing rates were lower at complexity 1b (OR 0.8, 95% CI 0.66–0.96) and 1c (OR 0.69, 95%CI 0.58–0.83) versus 2; rural-serving and volume were not associated with prescribing.</p> Conclusions <p>Use of SGLT-2i/GLP-1 RAs among patients with ischemic stroke increased modestly but remained low in those without diabetes. Substantial between-facility variation—particularly low prescribing rates at complexity class 1b/1c sites—highlights the need for future studies to evaluate barriers in prescribing.</p> Trial registration <p>ClinicalTrials.gov NCT04322162. Registration Date of 04/02/2020.</p>

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Trends in the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists among ischemic stroke patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月10日

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  • Qinglan Ding,
  • Jason J. Sico,
  • Anthony J. Perkins,
  • Laura J. Myers,
  • Joanne K. Daggy,
  • Ali Sexson,
  • Stanley E. Taylor,
  • Laura Burrone,
  • Kimberly Waddell,
  • Dawn M. Bravata

摘要

Background

Stroke is a leading cause of death and disability. Trials suggest that sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-receptor-1 receptor agonists (GLP-1 RAs) reduce cardiovascular risk in selected populations.

Objectives

To describe facility-level use of SGLT-2i/GLP-1 RAs among patients hospitalized with ischemic stroke in the US Department of Veterans Affairs (VA) hospitals and to examine facility determinants of prescribing.

Methods

We performed a retrospective trend analysis across 88 VA facilities (fiscal years 2020–2023). Prescribing was ascertained from VA pharmacy data; the outcome was the proportion of ischemic-stroke admissions receiving an SGLT-2i or GLP-1 RA. Facility-level binomial logistic models evaluated associations with VA hospital complexity (1, high; 2, low complexity), rural-serving, and volume.

Results

Among 17,093 admissions, facility-level prescribing ranged from 13.2% to 38.3%. Overall use increased from 21.8% (2020) to 30.1% (2023; P < 0.001), driven largely by patients with diabetes (38.9% to 51.5%); rates also increased in overweight patients (27.1% to 34.3%) but remained low in those without diabetes or overweight (3.4% to 7.0%, P = 0.010). Across years, 45.7% of patients with diabetes received therapy versus 7.8% without diabetes. In adjusted analyses, prescribing rates were lower at complexity 1b (OR 0.8, 95% CI 0.66–0.96) and 1c (OR 0.69, 95%CI 0.58–0.83) versus 2; rural-serving and volume were not associated with prescribing.

Conclusions

Use of SGLT-2i/GLP-1 RAs among patients with ischemic stroke increased modestly but remained low in those without diabetes. Substantial between-facility variation—particularly low prescribing rates at complexity class 1b/1c sites—highlights the need for future studies to evaluate barriers in prescribing.

Trial registration

ClinicalTrials.gov NCT04322162. Registration Date of 04/02/2020.