Suboptimal use of risk reduction therapy in peripheral arterial disease patients at a major teaching hospital

Abstract

BACKGROUND AND OBJECTIVES:Current evidence suggests that modification of atherosclerosis risk factors plays an important role in reducing adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). This study was undertaken to determine whether patients in this high-risk group were adequately using risk factor modification therapy.DESIGN AND SETTING:Prospective study of consecutive patients with PAD from a teaching hospital.PATIENTS AND METHODS:The collected data included information about atherosclerotic risk factors and utilization of risk factor modification therapyRESULTS:The 391 patients had a mean (standard deviation of 3 (1) atherosclerotic risk factors. Hypertension was identified in 56.8% of patients (222/391), of whom only 37.4% (83/222) had adequate blood pressure control (BP <140/90 mm Hg). The prevalence of diabetes mellitus (DM) was 35 % (137/391). Among patients with DM, only 49% (67/137) had adequate blood glucose control (glycosylated hemoglobin, HbA1c <7%). Statins were currently prescribed in 61% of patients (238/391), 38.7% (92/238) of whom continued to have low-density lipoprotein (LDL) >2.5 mmol/L, compared to a rate of 76.5% (117/153) among non-statin users (P<.001). The majority of patients of patients ( 72.4%; 283/391) were overweight/obese. Many patients (67.3%; 263/391) were nonsmokers; however, most (73.4%; 193/263) had a history of smoking. Antiplatelets were prescribed for 78.3% of patients (306/391), of whom 70.6% (216/306) were taking aspirin. Angiotensin converting enzyme (ACE) inhibitors were prescribed for 44.8% of patients (175/391). Among rampril users, only 36.8% of patients (53/144) were on an optimal dose.CONCLUSION:Although atherosclerotic risk factors were prevalent in patients with PAD, we found that patients received sub-optimal use of risk reduction treatments. Effective strategies to encourage health professionals to use these adjunctive therapies need to be developed.

The Burden of Major Adverse Cardiac Events and Antiplatelet Prevention in Patients with Coronary or Peripheral Arterial Disease

“…Between 74% (France) and 82% (multinational) of patients with PAD were prescribed antiplatelets. ASA prescription rates varied between 28% (the Netherlands) and 55% (Saudi Arabia) in this population. In Germany, 21% of patients with symptomatic PAD received clopidogrel, versus 43% for ASA .…”

“…Current patterns of antiplatelet secondary prophylaxis in patients with CAD or PAD were found in many reports. In total, 14 large observational studies based on database and registry data were selected (Table 3) [35,[40][41][42][43][44][45][46][47][48][49][50][51][52]. These studies covered a spectrum of countries from North America (Canada), Europe (including France, Germany, Poland, and The Netherlands) and Asia-Pacific (China, Japan, Saudi Arabia, and New Zealand).…”

Machine Learning to Predict Outcomes of Endovascular Intervention for Patients With PAD

“…There may be several factors contributing to suboptimal rates of best medical therapy, including lack of access to care, drug insurance coverage, or clinician time and education, among other factors. 36,37 There may be opportunities to improve rates of best medical therapy along with physical activity through patient education in the clinic, PAD awareness campaigns, and further integration of PAD education into medical school curricula. 38,39 Second, we found that preoperative factors were the most important predictors of 1-year MALE or death, while intraoperative features did not significantly improve model performance.…”

“…Therefore, there are opportunities to improve PAD care by understanding patients’ perioperative risk and optimizing them before and after revascularization. There may be several factors contributing to suboptimal rates of best medical therapy, including lack of access to care, drug insurance coverage, or clinician time and education, among other factors . There may be opportunities to improve rates of best medical therapy along with physical activity through patient education in the clinic, PAD awareness campaigns, and further integration of PAD education into medical school curricula .…”

Uptake of Best Medical Therapy: Secondary Prevention of Cardiovascular Disease in Vascular Surgical Patients in Western Australia

“…Despite demonstrated benefits, some studies have shown a lack of uptake of these medications in patient risk management. 7,20,21 A recent multi-center audit of BMT use in PAD patients post-ilioinguinal bypass demonstrated that 33.1% of patients were not discharged on BMT overall. 22 The authors reported that only 3.6% of patients were not discharged on any antithrombotic agent, either antiplatelet or anticoagulant.…”