Gaps in the quality of vascular care can worsen long-term health outcomes

According to a national registry, half of Medicare patients who underwent a procedure for symptom relief as it relates to lower extremity peripheral vascular disease did not receive the recommended medical therapy for long-term cardiovascular risk management.

First author Kim G. Smolderen, Ph.D., MSc, and senior author Carlos Mena-Hurtado, MD, co-directors of the vascular medicine outcomes group at Yale, evaluated the use of guideline-directed medical therapy (GDMT) over 24 months at a national level to help understand the impact of lack of GDMT with adverse outcomes. The study appears in the journal JACC: Cardiovascular Interventions.

The Society of Vascular Surgery and American College of Cardiology's Vascular Quality Initiative is an ongoing effort to document the outcomes of patients undergoing peripheral artery disease (PAD) procedures. PAD is widespread among underrepresented and marginalized populations. Comorbidities including smoking, hypertension, diabetes, and heart failure are common. One in five patients with a PAD diagnosis are at risk for death, heart attack, stroke, or amputation within a year.

Secondary prevention medications such as statins, antiplatelet therapy, or ACE/ARB in hypertensive patients are needed for long-term PAD care. The research team found that patients who are discharged following a peripheral vascular intervention without the recommended medications have an increased risk of death, and a 20% increased risk of a major amputation or limb loss within two years.

The unique features of this study were the use of Medicare linked outcomes data and the documentation of lack of GDMT that was linked with subsequent adverse prognosis. Undergoing expensive procedures that are intended to improve patients' functioning and quality of life, turned out to be really low value if patients' overall cardiovascular risk management is not addressed.