Abstract 14746: Region and Physician Specialty Influence Medical Management of Atherosclerotic Renal Artery Stenosis
Introduction: A lack of consensus exists regarding the optimal treatment for patients with atherosclerotic renal artery stenosis (ARAS). Little is known about regional trends in medication use and how physician specialty influences the medical management of this population.
Hypothesis: Regional variability and physician specialty influence the medical management of ARAS.
Methods: Medication data was available for 932 patients from the CORAL trial (Cardiovascular Outcomes in Renal Atherosclerotic Lesions). The United States (US) was divided into the 4 federal census bureau regions: Midwest, Northeast, South and West. Medications were classified as lipid-lowering (statin), anti-platelet, and 10 anti-hypertensive categories. Physician specialty affiliation was hypertensionologist, interventional cardiologist (IC), interventional radiologist (IR), or vascular surgeon (VS).
Results: We observed wide variation in the use of several classes of medication between clinical centers in the US (n=772) and outside the US (n=159). Patients outside the US took more anti-hypertensive medications (2.4 vs. 1.9, p<0.001) and were more likely to be treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (62% vs. 46%, p<0.001), calcium channel antagonist (58% vs. 37%, p<0.001), and statin (75% vs. 64%, p<0.05). Significant heterogeneity was observed in medications across the four census regions of the US. Patients in the South were less likely than those in other regions to take a calcium channel antagonist (p<0.001) and statin (p<0.01), and overall took fewer total anti-hypertensive medications (p<0.01). Patients in the Midwest were less likely to take an anti-platelet medication (p<0.05). Medical specialty also influenced the type and quantity of medications used. ICs and VSs were more likely to prescribe anti-platelet medications (p<0.001), while IRs prescribed fewer total medications (p<0.05).
Conclusions: Significant region-dependent variation exists in the medical therapy of ARAS. These variations are not explained by patient characteristics and are influenced by physician specialty.
- © 2013 by American Heart Association, Inc.