Many Patients with Ischemia Don't Receive Optimal Medical Therapy

Less than half of patients whose peripheral vascular disease progressed to critical limb ischemia (CLI) received optimal guideline-directed medical therapy (GDMT), new research suggests.

GDMT is a comprehensive treatment plan designed to reduce the risk of cardiovascular events and improve blood flow in the lower limbs. The authors collected recent data from the Vascular Quality Initiative. Of 28,652 patients undergoing an endovascular peripheral vascular intervention (PVI) between October 2016 and April 2019, 12,320 patients (43%) achieved optimal prescription rates of GDMT. Prior to the procedure 77% received antiplatelet therapy such as a statin or aspirin. The findings were published in Journal of the American College of Cardiology (JACC).

“We identified several high performing centers with almost no variation for GDMT prescription. The clinical pathway surrounding PVI could be an important opportunity to optimize patients’ care and outcomes, “ said Fiorella Llanos-Chea, MD, a clinical fellow at Yale and the first author of the study.

According to data published last year in JACC, patients with CLI are more likely to experience in-hospital major adverse cardiovascular events, limb loss, or mortality.

“We know that patients with CLI have some of the highest morbidity and mortality rates among patients who are diagnosed with peripheral artery disease (PAD). But they also have the most to gain from improved quality of care,” said Carlos Mena-Hurtado, MD, co-director of the Vascular Medicine Outcomes (VAMOS) program.

To assess variations in the quality of medical care, the authors recommend reviewing the highest performing centers to identify best practices. Kim Smolderen, PhD, who co-directs the VAMOS program with Mena-Hurtado, was awarded a $1 M grant to direct a nationwide multi-center registry SCOPE-CLI (Shifting Care and Outcomes for Patients with Endangered Limbs – Critical Limb Ischemia). “The aim of SCOPE-CLI is to examine the associations of patient and treatment characteristics with outcomes,” she said.

Yale co-authors of the study include Qurat-Ul-Ain Jelani, MD, Jeptha Curtis, MD, Craig Parzynski Jiaming Huang, Kamil Faridi, MD, and Jeffrey Turner, MD. Other co-authors were Camila Trejo-Paredes, MD.