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Risk-Modifying Medication Prescription and Compliance in Vascular Surgery Patients
Ahmed Kayssi, MD MSc MPH, George Oreopoulos, MD MSc, Leonard Tse, MD MASc, Barry B. Rubin, MD CM PhD, Thomas F. Lindsay, MD MSc, Graham Roche-Nagle, MD MBA.
University of Toronto, Toronto, ON, Canada.

OBJECTIVES: Despite strong evidence for the role of risk-modifying (RM) medications in the management of vascular disease, the extent to which vascular surgeons are involved in prescribing and monitoring the effects of these medications on their patients is unclear. The goals of this study were to describe the pre-operative RM medication profile of the vascular surgery patients at a major Canadian vascular tertiary care center, assess the impact of a hospital admission on a vascular surgery patient’s RF medication profile, and to evaluate the compliance of vascular surgery patients with RF medications post-discharge.
METHODS: A retrospective database review was carried out of all vascular surgery patients treated at our institution between August 2011 and February 2013. Baseline demographics and co-morbidities as well as pre- and post-hospitalization medication profiles were analyzed. Descriptive statistics and regression analysis were used to study the effect of a hospital admission on RF prescription patterns and compliance.
RESULTS: Five-hundred and eighty-five patients were identified in our database review (75% male, average age 70.8 ± 9.8 years). Most patients were on aspirin (ASA) (73%), a statin (77%), or a beta-blocker (52%) pre-operatively. The average stay in hospital was 7.7 ± 11.9 days and most patients (67%) were admitted for elective surgery. Of the patients who were not on ASA, a statin, or a beta-blocker pre-operatively, only 50%, 43%, and 29% were started on those medications after undergoing surgery, respectively. Factors significantly associated with being started on ASA, a statin, or a beta-blocker included discharge to a rehabilitation or long-term facility rather than home, and being on multiple medications pre-admission. Length of stay was also significantly associated with being started on a beta-blocker in hospital. The type of surgery that the patients underwent was not associated with being started on a RM medication. Three-hundred and forty-five (59%) patients followed-up with their surgeon within the first year post-discharge. Patients were more likely to be compliant with a RM medication in follow-up if they were already taking that medication before admission (ASA: 86% vs. 75%, Statin 94% vs. 89%, Beta-blocker 86% vs. 64%).
CONCLUSIONS: Our findings suggest that admission to a hospital generally improves RM medication prescription patterns. Future initiatives are needed to improve post-operative RM prescription patterns and medication compliance among vascular surgery patients.


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