If not now, when? Prescription of evidence-based medical therapy prior to hospital discharge increases utilization at 6 months in patients with symptomatic peripheral artery disease.
We evaluated the impact of the prescription of evidence-based medical therapy (EBMT) including aspirin (ASA), beta-blockers (BB), ACE-inhibitors or angiotensin receptor blockade (ACE/ARB), and statins prior to discharge after peripheral vascular intervention (PVI) on long-term medication utilization in a large multi-specialty, multicenter quality improvement collaborative. Among patients undergoing coronary revascularization, use of the component medications of EBMT at hospital discharge is a major predictor of long-term utilization. Predictors of EBMT use after PVI are largely unknown. A total of 10,169 patients undergoing PVI between 1 January 2008 and 31 December 2011 were included. Post-PVI discharge and 6-month medication utilization in patients without contra-indications to ASA, BB, ACE/ARB, and statins were compared. ASA was prescribed at discharge to 9345 (92%) patients, BB to 7012 (69%), ACE/ARB to 6424 (63%), and statins to 8342 (82%), and all four component drugs of EBMT in 3953 (39%). Compared with patients not discharged on the appropriate medications, post-procedural use was associated (all p<0.001) with reported 6-month use: ASA (84.5% vs 39.2%), BB (82.5% vs 11.1%), ACE/ARB (78.2% vs 11.8%), statins (84.6% vs 21.8%). Multivariable analysis revealed that prescription of EBMT at the time of discharge remained strongly associated with use at 6 months for each of the individual component drugs as well as for the combination of all four EBMT medications. In conclusion, prescription of the component medications of EBMT at the time of PVI is associated with excellent utilization at 6 months, while failure to prescribe EBMT at discharge is associated with low use of these medications 6 months later. These data suggest that the time of a PVI is a therapeutic window in which to prescribe EBMT in this high-risk cohort and represents an opportunity for quality improvement.
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Brian M
BM
Renard
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Milan
M
Seth
Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
David
D
Share
Michigan Heart, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
Herb D
HD
Aronow
Botsford Hospital, Farmington Hills, MI, USA.
Eugene W
EW
Laveroni
Cardiology and Vascular Associates, St Joseph Mercy Oakland Hospital, Pontiac, MI, USA.
Michele
M
De Gregorio
St John Macomb Hospital, Warren, MI, USA.
Sachinder S
SS
Hans
Department of Surgery, Division of Vascular Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Peter K
PK
Henke
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Hitinder S
HS
Gurm
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, MI, USA pagross@umich.edu.
P Michael
PM
Grossman
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D013997:Time Factors
D002317:Cardiovascular Agents
evidence-based medical therapy; peripheral artery disease; peripheral vascular intervention; quality improvement