Optimal Medical Treatment Under-used in Vascular Peripheral Disease

Less than half of patients undergoing endovascular revascularization for peripheral artery disease to their lower limbs are discharged with optimal medical treatment. 

Subutilización del tratamiento médico en enfermedad vascular periférica

Their traditional risk factors are predictors of a more comprehensive treatment; however, women, patients with higher risk of thrombosis, and those more likely to lose a lower limb, are far from being treated optimally.

When reading these outcomes, we tend to believe most physicians think women are not at risk and, on the opposite side of the spectrum, those at risk of amputation are too far gone to even try.

The aim of this study was to look into indications at discharge of patients treated with lower limb endovascular intervention.

According to guidelines, optimal medical treatment is prescribed at discharge when patients are under antiplatelet therapy, statins and one inhibitor of the angiotensin convertor enzyme (ACEI) or an angiotensin receptor blocker (ARB). 


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Of the 12316 patients included, only 47.4% (n=5844) were discharged with optimal medical treatment. Most patients were on antiaggregants (95.2%), many on statins (83.5%) and a few on ACEI or ARB (55.8%).

80.5% of patients had a class I indication for antiaggregants. 

At multivariable analysis, it was seen that female sex, old age, kidney failure, critical lower limb ischemia, and cardiac failure were predictors of NO optimal medical treatment, against guideline recommendation. 


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On the flipside, hypertension, diabetes, heart disease and revascularization procedures were positive predictors of optimal medical treatment. 

Conclusion

Less than half of patients undergoing endovascular lower limb revascularization are discharged with optimal medical treatment against guideline recommendation. Both patients and physicians should make a serious effort to close this gap.  

Original Title: Predictors of Underutilization of Medical Therapy in Patients Undergoing Endovascular Revascularization for Peripheral Artery Disease.

Reference: S. Elissa Altin et al. J Am Coll Cardiol Intv 2020;13:2911–8.


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