Division of Cardiology, Yale University, New Haven, Connecticut, USA; West Haven VA Medical Center, West Haven, Connecticut, USA.
Division of Cardiology, Yale University, New Haven, Connecticut, USA.
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2911-2918. doi: 10.1016/j.jcin.2020.08.036.
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.
Little is known about contemporary GDMT prescription following LE PVI.
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.
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.
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.
本研究旨在探讨血管内下肢（LE）外周血管介入治疗后指南指导的药物治疗（GDMT）的出院处方率，定义为抗血小板药物、他汀类药物和 ACE 抑制剂或血管紧张素受体阻滞剂的综合使用。
关于 LE PVI 后当代 GDMT 处方的信息知之甚少。
在 2014 年至 2018 年血管研究组新英格兰血管质量倡议中，将性别、年龄和合并症与接受 LE PVI 治疗症状性外周动脉疾病的患者的出院 GDMT 处方相关联。多变量逻辑回归用于确定出院 GDMT 处方的独立预测因素。
在 12316 名患者中，仅有 47.4%（n=5844）在 LE PVI 后出院时接受 GDMT。大多数患者出院时使用抗血小板药物（95.2%），他汀类药物（83.5%）和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（55.8%）的处方较少。有更高比例的患者接受了 1 类指南推荐的抗血小板药物和他汀类药物治疗（80.5%）。多变量分析显示，女性、年龄较大、终末期肾病、慢性肢体威胁性缺血和充血性心力衰竭是出院 GDMT 处方的负预测因素，而高血压、糖尿病、冠状动脉疾病以及既往 LE PVI 或旁路是正预测因素。
接受 LE PVI 的患者中，不足一半的患者出院时接受了适当的 GDMT。正如预期的那样，传统的动脉粥样硬化危险因素和动脉粥样硬化疾病负担的测量与 GDMT 处方的可能性更大相关。然而，女性和发生动脉血栓形成和肢体丧失风险最高的患者最不可能开这些药物。需要开展针对提供者和患者的教育工作以缩小这些治疗差距。
