title: Prescription of Guideline-Based Medical Therapies at Discharge After Carotid Artery Stenting and Endarterectomy: An NCDR Analysis.
abstract: Carotid artery revascularization was previously found to incrementally reduce stroke risk among patients with carotid stenosis treated with medical therapy. However, the frequency with which optimal medical therapies are used at discharge after carotid endarterectomy (CEA) and carotid artery stenting (CAS) is not known, and the influence of patient, operator, and hospital characteristics on the likelihood of prescription is poorly understood.
  
  
  
  In a retrospective cohort study of 23 112 patients undergoing CAS or CEA between January 2007 and June 2012 at US hospitals participating in the CARE registry (Carotid Artery Revascularization and Endarterectomy), we examined antiplatelet therapy and statin utilization at discharge. Hierarchical multivariable logistic regression was used in adjusted analyses.
  
  
  
  Antiplatelet agents and statins were prescribed at discharge in 99% and 78%, respectively, after CAS and 93% and 75%, respectively, after CEA. After adjustment, antiplatelet therapy was more often prescribed after CAS than CEA (odds ratio 2.4 [95% confidence interval 1.68-3.45]), but statin prescription was equally likely (odds ratio 1.11 [95% confidence interval 0.84-1.49]). Operator specialty (medical>radiology/surgery) and hospital community setting (suburban>urban>rural) independently predicted antiplatelet and statin agent use at discharge, whereas hospital geographic location (Northeast>Midwest/South>West) predicted use of statins but not antiplatelet therapy at discharge.
  
  
  
  US antiplatelet agent and statin discharge prescription rates were suboptimal after both CAS and CEA and varied by revascularization modality, operating physician specialty, and hospital characteristics. Improved and more uniform utilization after these procedures will be critical to the success of comprehensive stroke risk reduction efforts.
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.). herbert.aronow@lifespan.org.
authors: Herbert D
authors: HD
authors: Aronow
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Kevin F
authors: KF
authors: Kennedy
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Siddharth A
authors: SA
authors: Wayangankar
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Barry T
authors: BT
authors: Katzen
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Peter A
authors: PA
authors: Schneider
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Alex
authors: A
authors: Abou-Chebl
authors: From the Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (H.D.A.); Mid-America Heart Institute, Kansas City, MO (K.F.K.); Cleveland Clinic Foundation, Cleveland, OH (S.A.W.); Miami Cardiac & Vascular Institute, Miami, FL (B.T.K.); Kaiser Permanente Medical Center, Honolulu, HI (P.A.S.); Baptist Health, Louisville, KY (A.A.-C.); Massachusetts General Hospital, Boston, MA (K.A.R.).
authors: Kenneth A
authors: KA
authors: Rosenfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000188:drug therapy / Q000601:surgery*; D011307:Drug Prescriptions; D016894:Endarterectomy, Carotid; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015607:Stents
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: carotid endarterectomy; carotid stenosis; carotid stent; drug therapy; stroke