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

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