National VQI Initiative Associated With Improved Prescription of Statin and Antiplatelet Medications Across Racial and Ethnic Groups

Abstract

In 2017, the Vascular Quality Initiative announced the first national initiative intended to improve prescription of antiplatelets and statins. We hypothesized that this national quality initiative would be associated with an increase in prescription of these medications and a decrease in previously noted racial disparities in evidence-based medical management. A retrospective analysis using VQI data from the suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention modules from January 2015 through July 2022 was performed. Inclusion criteria were center participation during the entire study period, age over 18 years, and no documented contraindication to statin or antiplatelet therapy. Exclusion criteria were acute limb ischemia or inpatient death. Frequency of statin prescription by racial group prior to and following announcement of the national initiative were compared. Multivariable logistic regression was performed separately for statin and antiplatelet prescription at discharge. Finally, a time series analysis was performed to assess changes in disparities over time. Overall, 202,900 patients were included, of whom 149,059 identified as White, 35,871 identified as Black or African American, 11,039 identified as Latinx/Hispanic, 2015 identified as Asian, 1031 identified as Indigenous (including American Indian, Alaskan Native, Native Hawaiian, or other Pacific Islander), and 3861 were designated unknown or other, including patients who identified with more than one race. Almost all racial and ethnic groups had a statistically significant improvement in the frequency of any statin prescription and new statin prescription (Table). Moreover, while the difference between groups was statistically significant prior to announcement of the national quality improvement initiative (P < .001), there was no statistically significant difference between groups after (P = .05). On adjusted analysis, following the national quality improvement initiative, patients had an increased odds of both statin (odds ratio [OR], 1.5; P < .001; 95% confidence interval [CI], 1.4-1.6), new statin (OR, 1.4; P < .001; 95% CI, 1.4-1.5), nonaspirin antiplatelet (OR, 1.5, P < .001; 95% CI, 1.5-1.6), and new nonaspirin antiplatelet prescription (OR, 1.5, P < .001; 95% CI, 1.5-1.6). There was no statistically significant difference in the odds of new aspirin prescription. A time series analysis demonstrated continued improvement of statin prescription for all racial and ethnic groups, with a convergence around 90% (Figure). The first national VQI quality initiative was associated with a reduction in the disparities in statin prescription and nonaspirin antiplatelet prescription across all ethnic groups. These findings highlight the impact VQI-based national quality initiatives may have on racial and ethnic disparities in medical management.TableStatin prescription at dischargeAny statin prescriptionNew statin prescriptionPre-Post-DifferenceP valuePre-Post-DifferenceP valueWhite80.5%88.2%+7.8%.00126%37.8%+11.8%.001Black or African American79.7%88.2%+8.6%.00129.8%42.2%+12.4%.001Latinx/Hispanic82%87.7%+5.7%.00131.9%38.9%+7%.001Unknown or other77.6%86.6%+9%.00127.2%38.7%+11.5%.001Asian83.8%87%+3.2%.0527.9%37.9%+10%.05Indigenous (including American Indian, Alaskan Native, Native Hawaiian, or other Pacific Islander)77.2%86.5%+9%.00133.3%39.5%+6.2%.33 Open table in a new tab