Predictors of Underutilization of Medical Therapy in Patients Undergoing Endovascular Revascularization for Peripheral Artery Disease.

Autor:	Altin SE; Division of Cardiology, Yale University, New Haven, Connecticut, USA; West Haven VA Medical Center, West Haven, Connecticut, USA. Electronic address: elissa.altin@yale.edu., Castro-Dominguez YS; Division of Cardiology, Yale University, New Haven, Connecticut, USA., Kennedy KF; Midwest Bioinformatics, St. Luke's Mid America Heart Institute, Kansas City, Missouri, USA., Orion KC; Section of Vascular Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA., Lanksy AJ; Division of Cardiology, Yale University, New Haven, Connecticut, USA; Barts Heart Centre, University College London and Queen Mary University of London, London, United Kingdom, USA., Abbott JD; Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA., Aronow HD; Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Dec 28; Vol. 13 (24), pp. 2911-2918.
DOI:	10.1016/j.jcin.2020.08.036
Abstrakt:	Objectives: The aim of this study was to explore discharge prescription rates of guideline-directed medical therapy (GDMT), defined as aggregate antiplatelet agent, statin, and ACE inhibitor or angiotensin receptor blocker use after endovascular lower extremity (LE) peripheral vascular intervention. Background: Little is known about contemporary GDMT prescription following LE PVI. Methods: Sex, age, and comorbid conditions were related to discharge GDMT prescription among patients undergoing LE PVI for symptomatic peripheral artery disease in the 2014-2018 Vascular Study Group of New England Vascular Quality Initiative. Multivariate logistic regression was used to identify independent predictors of discharge GDMT prescription. Results: Among 12,316 patients, only 47.4% (n = 5,844) were discharged on GDMT after LE PVI. Most patients were discharged on antiplatelet agents (95.2%), with statins (83.5%) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (55.8%) prescribed less often. A higher proportion of patients were on Class 1 guideline-recommended therapy with antiplatelet agents and statins (80.5%). In multivariate analysis, female sex, older age, end-stage renal disease, chronic limb-threatening ischemia, and congestive heart failure were negative predictors of discharge GDMT prescription, while hypertension, diabetes, coronary artery disease, and prior LE PVI or bypass were positive predictors. Conclusions: Fewer than one-half of patients undergoing LE PVI are discharged on appropriate GDMT. As expected, traditional atherosclerotic risk factors and measures of greater atherosclerotic disease burden were associated with a greater likelihood of GDMT prescription. However, women and patients with the highest risk for atherothrombosis and limb loss were least likely to be prescribed these agents. Provider- and patient-directed educational efforts are needed to close these treatment gaps. Competing Interests: Author Disclosures Dr. Abbott has conducted research (no direct compensation) for AstraZeneca; and has performed clinical trial adjudication for Recor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu