Improvement in Optimal Discharge Medications Within the Vascular Quality Initiative is Associated with Improved Long-term Survival

Objectives Optimal medical management (OMM) with antiplatelet and statin agents after vascular surgery procedures is associated with improved 5-year survival. The aim of this study was to report the uptake of OMM after a prior publication in 2014 on OMM use within the Vascular Quality Initiative (VQI) and evaluate subsequent patient outcomes. Methods VQI patients undergoing elective carotid artery stenting (n=61,950), carotid endarterectomy (n=141,520), peripheral vascular intervention (n=182,250), supra (n=14,128) and infrainguinal bypass (n=37,556), thoracic endovascular aortic repair (n=15,415), open (n=10,240) and endovascular aneurysm repair (n=60,068) from 2005-2022 were included. OMM was defined as antiplatelet and statin use at discharge. Our primary outcomes were OMM use and long-term survival. Patients were divided into groups before and after prior publication on OMM, Group 1: 2005-2013 and Group 2: 2014-2022. A Cochran-Armitage trend test of rates of OMM over time, along with interrupted time series analysis assessed the temporal trend in the utilization of OMM. Kaplan-Meier and Cox Proportional Hazards models assessed time-to-event data. Results OMM at discharge significantly increased (p trend <0.001) over the years (2005-2022). A greater number of patients in Group 2 were on OMM (80.0 vs 71.7%%, p<0.001). The rate of increase in OMM in the 2014-2022 era was not significantly different from the rate of increase from 2005-2013 (p=0.19). Patients in Group 2 had higher overall survival at 5 years (84.1% vs 81.3%) and 10 years (79.4% vs 73.7%), p<0.001. Similarly, patients on OMM at discharge had higher survival at both 5 and 10 years compared to those on neither or either of statins or antiplatelets (5 years: 84.3% vs 79.9%; 10 years: 77.7% vs 73.8%; p<0.001). In a multivariable Cox proportional hazards model, patients in Group 2 had significantly lower risk of death (Hazard Ratio [HR] 0.75, 95% CI 0.73-0.77, p<0.001) and patients on OMM had significantly decreased risk of death (HR 0.90, 95% CI 0.87-0.92, p<0.001) after adjusting for other comorbidities and procedure type. Conclusions The improvement in OMM use in VQI has been steady since 2005, approaching 85% in current practice. OMM continues to be significantly associated with improved long-term survival. Therefore, managing patients with OMM is vital for improved outcomes after vascular surgery procedures.