Back to 2025 Display Posters
Medication Nonadherence Is Associated With Increased Morbidity But Not Mortality After Lower Extremity Revascularization In Patients With PAD.
Michelle C. Zhang, MD, Alexandra Sansosti, MD, Madeleine Hunter, MD, Ian Kronish, MD, Thomas F.X. O'Donnell, MD.
NYP-Columbia University Irving Medical Center, New York, NY, USA.
OBJECTIVES: Medical management of peripheral artery disease (PAD) consists of antiplatelet therapy, cholesterol reduction, blood pressure control, and anticoagulation. These medications are associated with lower mortality, improved quality of life, and fewer adverse limb events in patients with PAD. Few studies have examined prescribing patterns and medication adherence after lower extremity endovascular intervention. This study evaluates how adherence to medications affects reintervention, subsequent amputation, and mortality.
METHODS: We identified all patients after lower extremity endovascular revascularization at an urban academic institution for PAD between 1/1/23-10/31/23. Pharmacy dispense reports were utilized to calculate proportion of days covered (PDC) for 90d postoperatively. Demographic variables including age, race, language, and sex were tabulated. We collected PDC data for thienopyridines, anticoagulation, statin, beta-blockers (BB), angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACE/ARB), metformin, sulfonylureas, and other non-insulin antihyperglycemics using the electronic health record, supplemented with direct pharmacy queries for fill data. Outcome measures were reintervention, minor and major amputation, 90-day mortality and followup.
RESULTS: There were 163 patients in our study population; 35% were female, 21% were Black, 45% Hispanic. Nonadherence ranged from 27.1% for metformin to 42.9% for anticoagulants. Forty-one patients (25.3%) underwent repeat endovascular revascularization, 27 (16.7%) received minor and 15 (9.2%) received major amputation, 105 (64.8%) were readmitted, 122 (75.3%) attended a followup appointment, and 7 (4.3%) died within 90d. Lower adherence is associated with being uninsured (0.15 [CI 0.003-0.371], p=0.05) and black race ( 0.19 [CI 0.006-0.075], p=0.01). Multivariable analysis showed Hispanic patients were more likely to undergo major amputation compared to non-Hispanic patients (3.7 [CI 0.005-0.198], p=0.04). Anticoagulation nonadherence was associated with higher rates of minor (-0.304 [CI 0.548-0.055], p 0.02) and major (-0.395 [0.211-0.835], p = 0.02) amputation. There was no difference for rates of 90d reintervention, major or minor amputation, or death in any other adherence data.
CONCLUSIONS: Medication adherence is associated with lower morbidity after lower extremity endovascular revascularization. Notably, Hispanic patients are at higher risk for limb loss, and anticoagulant nonadherence is associated with higher amputation risk. Future efforts should investigate the reasons - such as cost and health literacy - why patients are nonadherent to medications.
Back to 2025 Display Posters
