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Predictors of Underutilization of Medical Therapy in Patients Undergoing Endovascular Revascularization for

S Elissa Altin1, Yulanka S Castro-Dominguez2, Kevin F Kennedy3

  • 1Division of Cardiology, Yale University, New Haven, Connecticut, USA; West Haven VA Medical Center, West Haven, Connecticut, USA.

JACC. Cardiovascular Interventions
|December 28, 2020
PubMed

Insights

Less than half of patients receive guideline-directed medical therapy (GDMT) after lower extremity (LE) peripheral vascular intervention (PVI). Women and high-risk patients were less likely to receive GDMT, highlighting a need for improved prescription practices.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Health Outcomes Research

Background:

  • Guideline-directed medical therapy (GDMT) is crucial for managing patients with peripheral artery disease (PAD).
  • Contemporary prescription rates of GDMT following lower extremity (LE) endovascular peripheral vascular intervention (PVI) are not well-established.
  • Understanding factors influencing GDMT prescription is vital for optimizing patient care.

Purpose of the Study:

  • To investigate the discharge prescription rates of GDMT after LE PVI.
  • To identify predictors of GDMT prescription in patients undergoing LE PVI for symptomatic PAD.

Main Methods:

  • Analysis of data from the 2014-2018 Vascular Study Group of New England Vascular Quality Initiative.
  • Inclusion of 12,316 patients undergoing LE PVI for symptomatic PAD.
  • Multivariate logistic regression to identify independent predictors of discharge GDMT prescription.

Main Results:

  • Only 47.4% of patients were discharged on GDMT (antiplatelet agent, statin, ACE inhibitor/ARB).
  • Antiplatelet agents were most common (95.2%), followed by statins (83.5%) and ACE inhibitors/ARBs (55.8%).
  • Female sex, older age, end-stage renal disease, chronic limb-threatening ischemia, and congestive heart failure were negative predictors; hypertension, diabetes, CAD, and prior interventions were positive predictors.

Conclusions:

  • Fewer than half of patients undergoing LE PVI receive appropriate GDMT.
  • While traditional risk factors predict GDMT use, women and high-risk patients are less likely to receive it.
  • Educational interventions are needed to address treatment gaps and improve GDMT prescription rates.
Abstract

Keywords:
guideline-directed medical therapyperipheral artery diseasesex differences

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