Renard Brian M, Seth Milan, Share David, Aronow Herb D, Laveroni Eugene W, De Gregorio Michele, Hans Sachinder S, Henke Peter K, Gurm Hitinder S, Grossman P Michael
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Vasc Med. 2015 Dec;20(6):544-50. doi: 10.1177/1358863X15599249. Epub 2015 Aug 31.
We evaluated the impact of the prescription of evidence-based medical therapy (EBMT) including aspirin (ASA), beta-blockers (BB), ACE-inhibitors or angiotensin receptor blockade (ACE/ARB), and statins prior to discharge after peripheral vascular intervention (PVI) on long-term medication utilization in a large multi-specialty, multicenter quality improvement collaborative. Among patients undergoing coronary revascularization, use of the component medications of EBMT at hospital discharge is a major predictor of long-term utilization. Predictors of EBMT use after PVI are largely unknown. A total of 10,169 patients undergoing PVI between 1 January 2008 and 31 December 2011 were included. Post-PVI discharge and 6-month medication utilization in patients without contra-indications to ASA, BB, ACE/ARB, and statins were compared. ASA was prescribed at discharge to 9345 (92%) patients, BB to 7012 (69%), ACE/ARB to 6424 (63%), and statins to 8342 (82%), and all four component drugs of EBMT in 3953 (39%). Compared with patients not discharged on the appropriate medications, post-procedural use was associated (all p<0.001) with reported 6-month use: ASA (84.5% vs 39.2%), BB (82.5% vs 11.1%), ACE/ARB (78.2% vs 11.8%), statins (84.6% vs 21.8%). Multivariable analysis revealed that prescription of EBMT at the time of discharge remained strongly associated with use at 6 months for each of the individual component drugs as well as for the combination of all four EBMT medications. In conclusion, prescription of the component medications of EBMT at the time of PVI is associated with excellent utilization at 6 months, while failure to prescribe EBMT at discharge is associated with low use of these medications 6 months later. These data suggest that the time of a PVI is a therapeutic window in which to prescribe EBMT in this high-risk cohort and represents an opportunity for quality improvement.
我们在一个大型多专科、多中心质量改进协作项目中，评估了外周血管介入治疗（PVI）后出院前开具包括阿司匹林（ASA）、β受体阻滞剂（BB）、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACE/ARB）以及他汀类药物在内的循证医学疗法（EBMT）对长期药物使用的影响。在接受冠状动脉血运重建的患者中，出院时使用EBMT的组成药物是长期使用的主要预测指标。PVI后使用EBMT的预测因素很大程度上未知。纳入了2008年1月1日至2011年12月31日期间接受PVI的10169例患者。比较了无ASA、BB、ACE/ARB和他汀类药物使用禁忌的患者PVI后出院时及6个月时的药物使用情况。出院时，9345例（92%）患者开具了ASA，7012例（69%）开具了BB，6424例（63%）开具了ACE/ARB，8342例（82%）开具了他汀类药物，3953例（39%）患者开具了EBMT的所有四种组成药物。与未出院时开具适当药物的患者相比，术后使用与报告的6个月使用情况相关（所有p<0.001）：ASA（84.5%对39.2%）、BB（82.5%对11.1%）、ACE/ARB（78.2%对11.8%）、他汀类药物（84.6%对21.8%）。多变量分析显示，出院时开具EBMT与6个月时每种单独组成药物以及所有四种EBMT药物组合的使用仍密切相关。总之，PVI时开具EBMT的组成药物与6个月时的良好使用情况相关，而出院时未开具EBMT与6个月后这些药物的低使用情况相关。这些数据表明，PVI时机是在这个高危队列中开具EBMT的治疗窗口，也是质量改进的一个机会。
