PMID- 25601506 OWN - NLM STAT- MEDLINE DCOM- 20150527 LR - 20181113 IS - 1097-6809 (Electronic) IS - 0741-5214 (Print) IS - 0741-5214 (Linking) VI - 61 IP - 4 DP - 2015 Apr TI - Participation in the Vascular Quality Initiative is associated with improved perioperative medication use, which is associated with longer patient survival. PG - 1010-9 LID - S0741-5214(14)02200-9 [pii] LID - 10.1016/j.jvs.2014.11.073 [doi] AB - OBJECTIVE: Medical management (MM) with antiplatelet (AP) and statin therapy is recommended for most patients undergoing vascular surgery and has been advocated by the Vascular Quality Initiative (VQI). We analyzed the effect of VQI participation on perioperative (preoperative and postoperative) MM use over time and the effect of discharge MM on patient survival. METHODS: We studied VQI patients treated with MM preoperatively and at discharge from 2005 to 2014, including all elective carotid endarterectomy/carotid stenting (n = 28,092), suprainguinal/infrainguinal bypass (n = 11,362), peripheral vascular interventions (n = 24,476), open/endovascular abdominal aortic aneurysm repair (n = 13,503), and thoracic endovascular aneurysm repair (n = 702). We examined trends of MM use over time, as well as the effect of duration of VQI participation on MM use. Multivariable logistic regression analysis was performed to identify factors associated with MM use. In addition, the Cox proportional hazards model was used to identify factors associated with 5-year survival. RESULTS: MM with AP and statin preoperatively and postoperatively across VQI centers improved from 55% in 2005 to 68% in 2009, with a subsequent overall decline to 62% by 2014, coincident with many new centers with lower MM rates joining VQI in 2010. Longer center participation in VQI was associated with improved perioperative MM overall. This was also noted across all procedure types, with MM increasing from 47% to 82% for aneurysm repairs and 69% to 83% for carotid procedures from 1 to 12 years of participation in VQI. After multivariable adjustment, centers in VQI >/=3 years were 30% more likely to have patients on MM (odds ratio, 1.3, 95% confidence interval [CI], 1.3-1.4). Importantly, discharge on AP and statin therapy was associated with improved 5-year survival, compared with discharge on neither medication (82% [95% CI, 81%-83%] vs 67% [95% CI, 62%-72%]), and an adjusted hazard ratio for death of 0.6 (95% CI, 0.5-0.7; P < .001). Discharge on a single medication was associated with intermediate survival at 5 years (AP only: 77% [95% CI, 75%-79%]; statin only: 73% [95% CI, 68%-77%]). CONCLUSIONS: These data demonstrate that MM is associated with improved survival after a number of vascular procedures. Importantly, VQI participation improves the use of MM, demonstrating that involvement in an organized quality effort can affect patient outcomes. CI - Copyright (c) 2015 Society for Vascular Surgery. All rights reserved. FAU - De Martino, Randall R AU - De Martino RR AD - Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: demartino.randall@mayo.edu. FAU - Hoel, Andrew W AU - Hoel AW AD - Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill. FAU - Beck, Adam W AU - Beck AW AD - Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla. FAU - Eldrup-Jorgensen, Jens AU - Eldrup-Jorgensen J AD - Department of Surgery, Maine Medical Center, Portland, Me. FAU - Hallett, John W AU - Hallett JW AD - Roper St. Francis Heart & Vascular Center, Charleston, SC. FAU - Upchurch, Gilbert R AU - Upchurch GR AD - Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va. FAU - Cronenwett, Jack L AU - Cronenwett JL AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. FAU - Goodney, Philip P AU - Goodney PP AD - Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH. CN - Vascular Quality Initiative LA - eng GR - K08 HL105676/HL/NHLBI NIH HHS/United States GR - R21 HS021581/HS/AHRQ HHS/United States PT - Journal Article DEP - 20150116 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Platelet Aggregation Inhibitors) SB - IM CIN - J Vasc Surg. 2015 Apr;61(4):1019. PMID: 25601507 MH - Aged MH - Aged, 80 and over MH - Chi-Square Distribution MH - Female MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Patient Discharge/standards MH - Perioperative Care/adverse effects/mortality/*standards MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Practice Patterns, Physicians'/*standards MH - Proportional Hazards Models MH - Quality Improvement/*standards MH - Quality Indicators, Health Care/*standards MH - Registries MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vascular Surgical Procedures/adverse effects/mortality/*standards PMC - PMC5315460 MID - NIHMS844824 COIS- Author conflict of interest: none. EDAT- 2015/01/21 06:00 MHDA- 2015/05/28 06:00 PMCR- 2017/02/17 CRDT- 2015/01/21 06:00 PHST- 2014/10/13 00:00 [received] PHST- 2014/11/13 00:00 [accepted] PHST- 2015/01/21 06:00 [entrez] PHST- 2015/01/21 06:00 [pubmed] PHST- 2015/05/28 06:00 [medline] PHST- 2017/02/17 00:00 [pmc-release] AID - S0741-5214(14)02200-9 [pii] AID - 10.1016/j.jvs.2014.11.073 [doi] PST - ppublish SO - J Vasc Surg. 2015 Apr;61(4):1010-9. doi: 10.1016/j.jvs.2014.11.073. Epub 2015 Jan 16.