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Prescription of Guideline-Based Medical Therapies After CEA and CAS
Study Questions:
What are the rates of prescription of guideline-based medical therapies at discharge after carotid artery stenting (CAS) and endarterectomy (CEA)?
Methods:
In a retrospective cohort study of 23,112 patients undergoing CAS or CEA between January 2007 and June 2012 at US hospitals participating in the CARE registry (Carotid Artery Revascularization and Endarterectomy), the investigators examined antiplatelet therapy and statin utilization at discharge. Hierarchical multivariable logistic regression was used in adjusted analyses.
Results:
Antiplatelet agents and statins were prescribed at discharge in 99% and 78%, respectively, after CAS and 93% and 75%, respectively, after CEA. After adjustment, antiplatelet therapy was more often prescribed after CAS than CEA (odds ratio, 2.4; 95% confidence interval, 1.68-3.45), but statin prescription was equally likely (odds ratio, 1.11; 95% confidence interval, 0.84-1.49). Operator specialty (medical>radiology/surgery) and hospital community setting (suburban>urban>rural) independently predicted antiplatelet and statin agent use at discharge, whereas hospital geographic location (Northeast>Midwest/South>West) predicted use of statins, but not antiplatelet therapy at discharge.
Conclusions:
The authors concluded that antiplatelet agent and statin discharge prescription rates were suboptimal after both CAS and CEA and varied by revascularization modality, operating physician specialty, and hospital characteristics.
Perspective:
This study reports suboptimal rates of antiplatelet therapy and statin prescription at discharge after CAS and CEA among those without reported contraindications. Although only 4% of eligible patients were discharged without an antiplatelet agent, one in four went home without a statin. Use rates varied by revascularization modality, operating physician specialty, and hospital characteristics. There are significant opportunities to improve and reduce variability in utilization of evidence-based medical therapy in this high-risk patient setting.
Keywords: Carotid Stenosis, Drug Therapy, Endarterectomy, Carotid, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Patient Discharge, Platelet Aggregation Inhibitors, Stents, Stroke, Secondary Prevention, Vascular Diseases
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