Suboptimal use of cardiovascular risk modification therapies among patients undergoing vascular surgery admitted with chronic limb-threatening ischemia

<h2>Abstract</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> : 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). <h3>Conclusions</h3> 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.