Cardiovascular risk reduction in referrals to outpatient vascular clinics

Abstract

Introduction Patients with peripheral arterial disease (PAD), aneurysmal disease (AD) or carotid atherosclerosis are at high cardiovascular risk, necessitating secondary cardiovascular protection. The aim of this study was to determine compliance with cardiovascular risk reduction guidelines in new patients referred to vascular clinics. Methods A multicentre collaborative national observational audit of new patients referred to eight tertiary general vascular clinics over a three-month period in England and Wales was conducted by the Vascular and Endovascular Research Network (VERN). Referral letters, case notes and investigations were reviewed by local investigators, and data analysed by VERN. Results A total of 656 patients were included in the study: 73.2% had PAD, 23.2% had AD and 3.7% had carotid atherosclerosis. A third (37.5%) were current smokers, two-thirds (61.7%) were on antiplatelet therapy and two-thirds (61.5%) were on statin therapy. Smoking was more prevalent in the PAD cohort (PAD 41.4%, AD 27.5%, p=0.003). However, more PAD patients were on antiplatelet therapy (PAD 63.9%, AD 53.3%, p=0.024). Both antiplatelet and statin prescription significantly increased with the number of cardiovascular risk factors. Patients with a previous cardiac or cerebrovascular history were more likely to have stopped smoking, and to be on antiplatelet and statin therapy (p<0.0001 for each). Overall, 47.3% of patients were on both antiplatelet and statin therapy, and 28.9% were on antiplatelet and statin therapy and not smoking. Conclusions This study highlights deficiencies in cardiovascular risk minimisation in patients with established vascular disease. Patients with concomitant cardiac or cerebrovascular disease were more likely to be on best medical therapy

Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study

“…A two-phase survey was performed of UK and ROI consultant vascular surgeons between February 2017 and May 2019 via the Vascular and Endovascular Research Network (VERN), which is a vascular research collaborative consisting of vascular surgery trainees, vascular nurse specialists, vascular scientists and some vascular surgery consultants 11 with a proven track record for delivering multicentre research. [12][13][14][15] A modified Delphi consensus methodology was utilised. 16 Surveys were created using the Google TM Forms platform, and links to surveys were circulated to VERN members by email.…”

Groin wound infection after vascular exposure (GIVE) multicentre cohort study

“…GIVE was an international multicentre prospective observational cohort study of patients undergoing groin incision for access to the femoral arteries during vascular surgery. GIVE was designed and run by the Vascular and Endovascular Research Network (VERN; https://vascular-research.net/), a multidisciplinary trainee‐led vascular research collaborative, 19 with a track record for delivering on multicentre research projects 20‐24 . The study was conducted in hospitals providing emergency and/or elective vascular surgery.…”

“…GIVE was designed and run by the Vascular and Endovascular Research Network (VERN; https://vascularresearch.net/), a multidisciplinary trainee-led vascular research collaborative, 19 with a track record for delivering on multicentre research projects. [20][21][22][23][24] The study was conducted in hospitals providing emergency and/or elective vascular surgery. Invitations to participate were disseminated by VERN using social media, email, and personal contacts.…”

Analysis of the relationship between sex and prescriptions for guideline-recommended therapy in peripheral arterial disease, in relation to 1-year all-cause mortality: a primary care cohort study

“…4 Even so, excess mortality associated with a diagnosis of PAD is similar to that of coronary heart disease and stroke, due not only to systemic cardiovascular disease but higher rates of lung disease and malignancy. 5 6 In common with other cardiovascular conditions guideline-directed best practice recommendations, 7 that is, prescribing an antiplatelet and statin, is associated with reduced risk for all-cause mortality, myocardial infarction and stroke in the PAD cohort. 8 There is now a large volume of evidence…”