Aortic & peripheral vascular disease
Variability in guideline-directed medical therapy across sites and operators and long-term mortality and amputation outcomes risk in patients undergoing peripheral vascular interventions
Authors' conclusion
Both at the operator and health system level, there was significant variability in GDMT prescription following PVI, proportionally translating into risk for readmission, mortality, and major amputation.
Study context
- Population
- Patients undergoing peripheral vascular interventions (PVIs), 2017–2018, Medicare-linked Vascular Quality Initiative registry1,263 operators
- Participants
- 17,147 patients223 sites
- Exposure
- Lower vs higher guideline-directed medical therapy (GDMT) prescription rates by site and operator
- Outcome
- 90-day readmissions, 24-month all-cause mortality and major amputation
Methodological detailsregistry-based, multilevel (sites and operators nested within sites as random effects)
- Registry-based
- Multilevel (sites and operators nested within sites as random effects)
Main finding
As reported in the abstract
- GDMT rate range Q1
- Median odds ratios (MOR) 1.43 0% to 38% (95% CI 1.39-1.47, P ≤ .001)
- GDMT rate range Q4
- MOR 1.48 57%-100% (95% CI 1.44-1.51, P ≤ .001)
- Variance in GDMT use explained by sites and operators
- Four percent
- Intraclass correlation (ICC) sites
- 3.9 (95% CI 2.9-5.3)
- ICC operators
- 4.1 (95% CI 3.1-5.4)
- Dose-response: lower GDMT rates and higher 90-day readmission risk, by sites
- P = .021
- Dose-response: lower GDMT rates and higher 90-day readmission risk, by operators
- P < .001
- 24-month mortality per lower GDMT (per 10%) by site, HR
- 1.07 (95% CI 1.02-1.13)
- 24-month major amputation per lower GDMT by site, HR
- 1.08 (95% CI 1.01-1.15)
- Mortality per lower GDMT by provider, HR
- 1.05 (95% CI 1.02-1.08)
- Amputation per lower GDMT by provider, HR
- 1.04 (95% CI 1.00-1.08)
Observational data: associations, not effects.
Original publication
Variability in guideline-directed medical therapy across sites and operators and long-term mortality and amputation outcomes risk in patients undergoing peripheral vascular interventions. Am Heart J. Published 1 February 2024. doi:10.
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