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

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.