CINEMA Program at UH Boosting Quality of Care for Patients with Type 2 Diabetes at High Cardiovascular Risk, Study Shows
August 18, 2022
UH Clinical Update | August 2022
The CINEMA program at Univeristy Hospitals Harrington Heart & Vascular Institute, a transformative program directed at improving outcomes in patients with high-risk Type 2 diabetes, has demonstrated significant results in getting patients on evidence-based therapies such as SGLT2 inhibitors and GLP-1 receptor agonists and further driving down risk factors. That’s according to a new study published in the Journal of the American Heart Association, which looks at the first year results for the program.
CINEMA stands for Center for Integrated and Novel Approaches in Vascular-Metabolic Disease.
“Our team-based, patient-centered approach to high-risk disease management is a paradigm shift for care delivery in Type 2 diabetes mellitus, which results in dramatically improved outcomes within three months and is sustained at 12 months and beyond,” say Ian Neeland, MD, and Sadeer Al-Kindi, MD, Co-Directors of the CINEMA program and the first authors of the study. Dr. Neeland is also the Director of Cardiovascular Prevention Center for the UH Harrington Heart and Vascular Institute.
Why it matters: Current care for patients with Type 2 diabetes is often delayed, fragmented and high cost, says Sanjay Rajagopalan, MD, Founding Director of CINEMA, Chief of Cardiovascular Medicine and Chief Academic and Scientific Officer for University Hospitals Harrington Heart & Vascular Institute and the Herman K. Hellerstein, MD, Chair of Cardiovascular Research. These attributes make it particularly attractive for new solutions and possible disruptive innovation. Programs like CINEMA, he argues, could serve as a national model for empowering cardiologists to better manage patients with Type 2 diabetes who are at high cardiovascular risk – getting them on the latest therapies and eliminating a “defect” in care quality. Many studies have documented therapeutic inertia (long latencies in starting these medications), insurance barriers and lack of patient education when it comes to starting medications, which are by far the most important intervention for many of these patients.
One-year results for CINEMA: From May 2020 through August 2021, there were 417 referrals to the CINEMA program at UH and 206 patients were deemed eligible. Patients with Type 2 diabetes at high risk for cardiovascular events, including those with established atherosclerotic cardiovascular disease, elevated coronary artery calcium score >100, chronic heart failure with reduced ejection fraction, and/or chronic kidney disease stages 2 to 4, were included in the program. Of these 206 patients, 113 completed a baseline CINEMA visit and follow-up visit through December 2021.
Among CINEMA patients:
- Mean age was 59 years, with 49% women and 37% Black patients
- Cardiovascular risk factors improved significantly from baseline: Glycosylated hemoglobin (−10.8%), total cholesterol (−7.9%), LDL cholesterol (−13.5%), systolic blood pressure (−4.0%) and BMI (−2.7%) (P≤0.001 for all)
- Rates of SGLT2 inhibitor and GLP-1 receptor agonist prescriptions approximately doubled between the baseline and first follow-up visits. Among the 129 (63%) eligible patients not on SGLT2i or GLP-1 RA at baseline, 81% were prescribed evidence-based therapy with SGLT2i (n=66 [51%]) and/or GLP-1 RA (n=67 [52%]) to reduce the risk of cardiovascular disease in the initial 3-month follow-up period.
“Risk factor improvements generally continued with longer duration of program participation and were seen even among patients under the care of a cardiologist or endocrinologist,” Dr. Rajagopalan says.
Lessons learned: Dr. Rajagopalan says he hopes the UH CINEMA experience will help empower other specialists to provide evidence-based care for their patients with Type 2 diabetes in a similar centralized but specialized manner.
“An integrated, team-based, patient-centered approach to high-risk disease management seems to be a promising paradigm for care delivery,” he says. “We now need to figure out how to provide this at scale, which will include technology and lower cost personnel solutions.”