Seedlabs

ASCVD Incretin Switch Card

A card for doctors to help them decide whether to keep a heart patient on their current diabetes drug or switch.

A point-of-care shared-decision tool for cardiologists and endocrinologists that turns the first head-to-head cardiovascular trial of tirzepatide versus dulaglutide into a concrete continue-or-switch recommendation for each patient with type 2 diabetes and established heart disease.

MedicineDiabetes Treatment and Management
Attention Deficit Hyperactivity DisorderCardio-endocrinology clinical decision support

Concept

A standalone tablet/web decision card (no EHR integration required) for prescribers treating patients with type 2 diabetes and established atherosclerotic cardiovascular disease. The clinician enters five facts: current incretin, BMI, HbA1c, GI history, and the patient's stated priority (weight loss vs cardiovascular protection vs tolerability). The tool renders the head-to-head evidence and one of three pathway cards: (a) stay on dulaglutide — proven cardiovascular benefit and better GI tolerability — when weight is not the priority; (b) switch dulaglutide→tirzepatide, with a pre-built GI support plan, when obesity is undertreated; or (c) switch tirzepatide→dulaglutide after GI failure. Each card includes a patient-facing one-pager showing the actual trial numbers so the choice is a genuine shared decision.

Why now

This is the first active-comparator cardiovascular trial between incretin agents, run in exactly the secondary-prevention population prescribers manage — mean age 64.1, diabetes duration 14.7 years, HbA1c 8.4%, BMI 32.6. It demonstrated noninferiority (hazard ratio 0.92; P=0.003) but not superiority (P=0.09), alongside a clear tolerability trade-off (GI events 42.5% vs 35.9%; discontinuation 13.2% vs 10.1%). That combination — cardiovascular equivalence plus a weight-versus-tolerability trade-off — is precisely the kind of multi-factor choice that can now be codified into a decision aid, and the AHA's 2026 statistics [5] document the large and growing cardiovascular-kidney-metabolic population that will face it.

Written by GLM · 9 Oct 2026

AI assessment

Backed by 2 papers88

A highly focused, evidence-backed clinical decision tool that converts a specific head-to-head trial into a practical prescribing logic for a high-value patient population.

Evidence strength
5/5
The idea is directly derived from the specific results of a head-to-head trial (noninferiority for CV events, superiority in weight loss, inferiority in GI tolerance) provided in the full text.
Market pull
4/5
Cardiologists and endocrinologists managing the 'cardiovascular-kidney-metabolic' population have a high urgency to optimize these high-cost, high-impact therapies.
Novelty & moat
3/5
While it overlaps with the 'Stay-On Tirzepatide' idea regarding the drug switch, it shifts the value proposition from a coaching service to a clinical decision-support tool for the prescriber.
Feasibility
5/5
The tool is a simple logic-based calculator with a few inputs and static output cards, requiring minimal engineering to build a demoable MVP.
Wedge clarity
5/5
The wedge is extremely sharp: a specific decision point (Tirzepatide vs. Dulaglutide) for a specific patient profile (T2D with ASCVD).
Simplicity / focus
5/5
It avoids 'platform' creep by focusing on a single, standalone decision card rather than attempting full EHR integration or a broad disease management suite.

Scored by Gemma 4 · 9 Oct 2026. Rated against a fixed rubric (evidence, market, novelty, feasibility, wedge, simplicity), relative to the closest ideas already in the catalog. A prior estimate to compare ideas before real-world signal arrives.

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Who benefits

  • Obesity Medicine Associationorganization

    Its prescriber members field daily questions about which incretin to use in patients with heart disease; a validated switch card gives them an evidence-anchored answer to distribute.

  • Kaiser Permanenteorganization

    As an integrated delivery system with both cardiology and endocrinology under one formulary, Kaiser can standardize incretin switching across thousands of T2D patients with ASCVD using a single decision tool.

  • Cleveland Clinicorganization

    Its cardiovascular and obesity-medicine programs treat exactly the trial population (older T2D patients with established ASCVD and BMI ~32.6) and need a codified pathway for weight-motivated switching.

  • Eli Lilly and Companycompany

    Lilly markets both agents; whichever way the card points, the patient stays on a Lilly incretin, and the tool standardizes evidence-based use of its portfolio.

Research it builds on

  1. 2026 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association
    Latha P Palaniappan, Norrina B. Allen, Zaid Almarzooq et al. · 2026 · 223 citations
    All ideas from this paper →
  2. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes
    Stephen James Nicholls, Imre J. Pavo, Deepak L. Bhatt et al. · 2025 · 188 citations
    All ideas from this paper →
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feasibility