Abstract 11211: Guideline Directed Medical Therapy After Peripheral Vascular Intervention and One-Year Mortality in Patients with Peripheral Artery Disease in the Vascular Quality Initiative Medicare Linked Database

Abstract

Introduction: Guideline directed medical therapy (GDMT) for patients with peripheral artery disease (PAD) includes statin, antiplatelet, ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers) therapy if hypertensive. Undertreatment with GDMT is still common, and therefore we sought to quantify the association of receiving GDMT vs. not and subsequent mortality in patients undergoing peripheral vascular interventions (PVIs). Methods: The Vascular Quality Initiative linked with Medicare claims data through the VISION platform and contains data for PVIs between 2010 and 2018. Patient-level GDMT at discharge following the index PVI was defined as documentation of all of the following: statin, antiplatelet, and ACE/ARB therapy if hypertensive. Patients with less than three GDMT medications were the comparator. Mortality follow-up was censored to 12 months. Kaplan Meier curves were constructed for one-year mortality. The association between the receipt of GDMT following undergoing a PVI and mortality was quantified with a Cox proportional hazards model, adjusting for demographics, clinical history, and disease severity. Results: A total of 29,676 patients undergoing PVI were analyzed. Of those, 42.2% were female and the mean age was 71.9 (± 10.3) years. GDMT was administered in 64.9% of discharges. One-year mortality rates for those receiving no GDMT vs. complete GDMT was 23.4% vs. 17.3% (P < 0.001) (Figure 1). Not being on GDMT was associated with an increased risk of mortality (Unadjusted HR = 1.24, 95% confidence interval [CI 95%] 1.21-1.27; Adjusted HR = 1.22, 95% CI 1.19-1.25). Conclusions: Over a third of patients did not have documented GDMT after discharge for PVI, which was associated with an increased risk of mortality. There is a potential opportunity to improve outcomes for patients with PAD, who are at an increased risk of cardiovascular diseases, by improving adherence to evidence-based medical therapy.