Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia
Background: Patients with peripheral arterial disease (PAD) are at an increased risk of coronary artery disease and related complications. PAD and coronary artery disease share modifiable risk factors, and pharmacological treatment reduces cardiovascular (CV) events and mortality. Characterizing pre...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | JVS-Vascular Insights |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949912725000352 |
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| author | Mackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR Thomas Parker, BSc (Pharm), ACPR Susan Bowles, BSc (Pharm), MSc, PharmD, FCSHP Min Lee, MD, FRCSC Samuel Jessula, MD, MSc, FRCSC Michael MacNeil, PharmD, ACPR |
| author_facet | Mackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR Thomas Parker, BSc (Pharm), ACPR Susan Bowles, BSc (Pharm), MSc, PharmD, FCSHP Min Lee, MD, FRCSC Samuel Jessula, MD, MSc, FRCSC Michael MacNeil, PharmD, ACPR |
| author_sort | Mackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR |
| collection | DOAJ |
| description | Background: Patients with peripheral arterial disease (PAD) are at an increased risk of coronary artery disease and related complications. PAD and coronary artery disease share modifiable risk factors, and pharmacological treatment reduces cardiovascular (CV) events and mortality. Characterizing prescribing trends of evidence-based CV risk-modifying medications and recognizing care gaps are important steps in improving patient outcomes. The study objective was to determine the proportion of patients with PAD-related chronic limb-threatening ischemia prescribed CV risk-modifying medications (angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker [ACEi/ARB], statin, and antiplatelet) on discharge from vascular surgery care. Methods: This single-center, retrospective cohort study included patients with chronic limb-threatening ischemia admitted to the vascular surgery service at a tertiary care center. Inferential statistics were used to describe patients not prescribed CV risk-modifying medications. Multivariable logistic regression was used to determine any independent association of medication, disease, and demographic factors with a prescription for CV risk-modifying medications. Results: : A total of 178 patients met the inclusion criteria, of whom 56 (32%) were prescribed an ACEi/ARB, statin, and antiplatelet medication on admission and 76 (43%) at discharge. Coronary artery disease (adjusted odds ratio [aOR]: 2.23, 95% confidence interval [CI]: 1.09-4.55) and dyslipidemia (aOR: 3.84, 95% CI: 1.87-7.88) were associated with increased odds of being prescribed CV risk-modifying medications; atrial fibrillation was associated with decreased odds (aOR: 0.19, 95% CI: 0.06-0.61). Conclusions: Only 43% of the study population was prescribed an ACEi/ARB, statin, and antiplatelet medication at discharge, demonstrating a gap in care. The low prescribing rate of CV risk-modifying medications in this population warrants further investigation and highlights a key area to focus medical risk modification efforts. |
| format | Article |
| id | doaj-art-8dfe06cbc4464cd09dbcbf8bdb286106 |
| institution | OA Journals |
| issn | 2949-9127 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS-Vascular Insights |
| spelling | doaj-art-8dfe06cbc4464cd09dbcbf8bdb2861062025-08-20T02:31:57ZengElsevierJVS-Vascular Insights2949-91272025-01-01310021810.1016/j.jvsvi.2025.100218Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemiaMackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR0Thomas Parker, BSc (Pharm), ACPR1Susan Bowles, BSc (Pharm), MSc, PharmD, FCSHP2Min Lee, MD, FRCSC3Samuel Jessula, MD, MSc, FRCSC4Michael MacNeil, PharmD, ACPR5Pharmacy Department, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada; Correspondence: Mackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR,Victoria General Hospital, 1271 South Park St, Halifax, NS B3H 2Y9, CanadaPharmacy Department, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, NS, CanadaPharmacy Department, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, NS, Canada; College of Pharmacy, Dalhousie University, Halifax, NS, CanadaDivision of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS, CanadaDivision of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS, CanadaPharmacy Department, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health, Halifax, NS, CanadaBackground: Patients with peripheral arterial disease (PAD) are at an increased risk of coronary artery disease and related complications. PAD and coronary artery disease share modifiable risk factors, and pharmacological treatment reduces cardiovascular (CV) events and mortality. Characterizing prescribing trends of evidence-based CV risk-modifying medications and recognizing care gaps are important steps in improving patient outcomes. The study objective was to determine the proportion of patients with PAD-related chronic limb-threatening ischemia prescribed CV risk-modifying medications (angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker [ACEi/ARB], statin, and antiplatelet) on discharge from vascular surgery care. Methods: This single-center, retrospective cohort study included patients with chronic limb-threatening ischemia admitted to the vascular surgery service at a tertiary care center. Inferential statistics were used to describe patients not prescribed CV risk-modifying medications. Multivariable logistic regression was used to determine any independent association of medication, disease, and demographic factors with a prescription for CV risk-modifying medications. Results: : A total of 178 patients met the inclusion criteria, of whom 56 (32%) were prescribed an ACEi/ARB, statin, and antiplatelet medication on admission and 76 (43%) at discharge. Coronary artery disease (adjusted odds ratio [aOR]: 2.23, 95% confidence interval [CI]: 1.09-4.55) and dyslipidemia (aOR: 3.84, 95% CI: 1.87-7.88) were associated with increased odds of being prescribed CV risk-modifying medications; atrial fibrillation was associated with decreased odds (aOR: 0.19, 95% CI: 0.06-0.61). Conclusions: Only 43% of the study population was prescribed an ACEi/ARB, statin, and antiplatelet medication at discharge, demonstrating a gap in care. The low prescribing rate of CV risk-modifying medications in this population warrants further investigation and highlights a key area to focus medical risk modification efforts.http://www.sciencedirect.com/science/article/pii/S2949912725000352Peripheral arterial diseaseCritical limb-threatening ischemiaRisk modificationACEiStatinAntiplatelet |
| spellingShingle | Mackenzie d’Entremont-Harris, BSc, BSc (Pharm), ACPR Thomas Parker, BSc (Pharm), ACPR Susan Bowles, BSc (Pharm), MSc, PharmD, FCSHP Min Lee, MD, FRCSC Samuel Jessula, MD, MSc, FRCSC Michael MacNeil, PharmD, ACPR Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia JVS-Vascular Insights Peripheral arterial disease Critical limb-threatening ischemia Risk modification ACEi Statin Antiplatelet |
| title | Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia |
| title_full | Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia |
| title_fullStr | Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia |
| title_full_unstemmed | Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia |
| title_short | Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia |
| title_sort | suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb threatening ischemia |
| topic | Peripheral arterial disease Critical limb-threatening ischemia Risk modification ACEi Statin Antiplatelet |
| url | http://www.sciencedirect.com/science/article/pii/S2949912725000352 |
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