ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.
Objectives: Peripheral arterial disease (PAD) is estimated to affect 15% to 30% of the female U.S. population by 80 years of age. Women with PAD have different incidences of traditional modifiable risk factors as compared with men and are suspected to be underdiagnosed owing to atypical presentation, poor screening and an underappreciation of the prevalence of PAD in women. Additionally, women have faster functional decline as part of the natural course of their disease. For these reasons, we used the national Vascular Quality Initiative (VQI) database of femoropopliteal bypasses to identify non-mortality-related outcomes with female gender bias and to track gender attributable risk over time. Methods: Patients who underwent femoral-popliteal bypass, without prior open revascularization or amputation, and with occlusive pathology (n ¼ 7139) were selected for analysis. Seventy of 184 variables showed gender bias. Ambulatory status (AS), treatment indication (IND) and discharge location (DL) were selected for logistic regression. The cohort was further divided into four-time periods and risk associated with year of surgery among females was determined. Results: Females were more likely to have decreased ambulatory ability (HR, 1.48; P < .001), be treated for critical limb ischemia (CLI; HR, 1.60; P < .001) and be discharged to a nursing or rehabilitation facility (HR, 1.61; P < .001) at time of first bypass (Table). Over the four time periods assessed, the risk attributable to female gender for impaired AS, CLI as indication and skilled nursing facility as DL remained constant (HR, 1.27-1.58, 1.48-1.67 and 1.56-2.07, respectively; Fig). When year of surgery was used as a covariate for regression analysis, the year of intervention was not significantly associated with IND or DL. However, surgery year was significantly associated with decreased AS (HR, 1.039; P ¼ .028; Table). Conclusions: Female gender remains associated with decreased ambulatory function and more advanced femoropopliteal disease at time of first bypass. Among females, the year of surgery was not significantly associated with IND or DL but did confer increased risk for difficulty ambulating. This suggests that associations between female gender, AS, IND, and DL have at best has remained constant. This study demonstrates that women with PAD continue to be treated at more advanced stages of disease compared with men and that continued progress in this area is necessary.
Results: A total of 615 articles were identified from the literature search. After removal of excluded studies and duplicates, 6 RCT studies were available for analysis. Four of the 6 RCTs restricted their inclusion criteria to patient deemed at high risk for SSI development. In these studies, a total of 362 patients received ciNPT, and 371 patients received traditional dressings (control group). SSI events occurred in 41 ciNPT patients and 107 control patients. The heterogeneity test was non-significant (p>0.05). The meta-analysis showed a highly significant effect in favor of ciNPT (RR¼ 0.41, 95% CI 0.29 to 0.57, p< 0.00001). One limitation of this study is the varying RCT inclusion/exclusion criteria, such as differences in procedure types, and patient populations (some RCTs restricted to patients at high risk for complications). Conclusion: For this meta-analysis, ciNPT usage demonstrated a statistically significant reduction in the incidence of SSI relative to traditional dressings in patients undergoing vascular surgery with groin incisions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.