The prescription of best medical therapy following infrainguinal bypass grafting in Australia and New Zealand: a multicentre Australasian audit

Farah, Sam; Kwok, Ricky; Dean, Anastasia; Sivakumaran, Yogeesan; M, Khoo S; Joret, Maximilian O.; Jansen, Shirley; Aitken, Sarah

doi:10.1111/ans.16469

Cited by 4 publications

(11 citation statements)

References 25 publications

(48 reference statements)

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“…A recent ANZ study suggested that 460/688 (66.9%) patients that underwent infrainguinal bypass were prescribed an antihypertensive, lipid-lowering and antithrombotic medication. 14 This was similar to our study (62%) and highlights the under-prescribing of cardioprotective medications.…”

Section: Discussionsupporting

confidence: 91%

“…The decision to start lipid‐lowering medication is based on individual CVD risk, not cholesterol levels 19 . Despite this, lipid‐lowering medications was the most omitted medication, similar to other studies 14 . Furthermore, younger patients experienced a larger gap, with only 70% of the PAD population aged 40–49 years covered.…”

Section: Discussionsupporting

confidence: 73%

“…19 Despite this, lipid-lowering medications was the most omitted medication, similar to other studies. 14 Furthermore, younger patients experienced a larger gap, with only 70% of the PAD population aged 40-49 years covered. Younger patients in NZ have similarly been found to receive appropriate lipid-lowering medication despite adjustment for CVD risk.…”

Section: Lipid-lowering Medicationmentioning

confidence: 99%

“…Other PAD studies also suggest that antithrombotic medication is the least omitted CVD therapy. 5,14 Antiplatelet therapy was prescribed in 80% of patients and was associated with survival advantage. The reduction in risk of MACE with antiplatelets is well established.…”

Section: Antithrombotic Medicationsmentioning

confidence: 99%

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The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

Hart

Xue

Khashram

2023

ANZ Journal of Surgery

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BackgroundCardiovascular disease guidelines recommend that patients with established peripheral artery disease (PAD) are prescribed antihypertensive, lipid‐lowering, and antiplatelet medication to reduce cardiovascular ischaemic events. However, the prescribing of these medications for patients with PAD within New Zealand (NZ) remains undefined.MethodsThis was a retrospective observational cohort study of patients in the Midland region of NZ, that underwent PAD‐related percutaneous and surgical intervention between 1st January 2010 and 31st December 2021. Patient level data was collected. The primary outcome was prescribing of cardioprotective medications either before or within 1 year of incident procedure. Secondary outcome was overall survival.ResultsThere were 2547 patients included. Antihypertensive prescription occurred in 80.7%, lipid‐lowering in 77.4% and antithrombotic in 89.9%. Concomitant ischaemic heart disease increased prescription of cardioprotective medications. Women were prescribed less lipid‐lowering medication compared to men. Māori men were prescribed less antiplatelet medication compared to non‐Māori men. On univariate analysis lipid‐lowering and antiplatelet medication showed survival advantage, while antihypertensive and anticoagulation did not. After adjustment for age, sex, end stage renal failure and presence of chronic limb‐threatening ischaemia, best medical therapy was associated with better survival (HR 0.88, 95% CI 0.79–0.98, P = 0.02).ConclusionThis study highlights areas of deficiency in prescribing of cardioprotective medication in this high‐risk group. These could be targets for national quality improvement initiatives.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 73%

Section: Lipid-lowering Medicationmentioning

confidence: 99%

Section: Antithrombotic Medicationsmentioning

confidence: 99%

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The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

Hart

Xue

Khashram

2023

ANZ Journal of Surgery

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“…In another study, patients with PAD included in a guidelines-based risk reduction education program, which promoted overall control of cardiovascular risk factors and the use of drugs with demonstrated cardiovascular benefit, including statins, had a reduction in cardiovascular and lower extremity events at seven years of follow-up ( 176 ). However, the prescribing of these cardioprotective drugs remains insufficient and one-third of patients undergoing surgical revascularization do not receive them ( 177 ).…”

Section: Statin Prescription Rate In Patients With Peripheral Arterial Diseasementioning

confidence: 99%

Statins and Peripheral Arterial Disease: A Narrative Review

Jansen-Chaparro

López-Carmona

Cobos-Palacios

et al. 2021

Front. Cardiovasc. Med.

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Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic condition. In patients with PAD, the presence of intermittent claudication leads to a deterioration in quality of life. In addition, even in asymptomatic cases, patients with PAD are at high risk of cardiac or cerebrovascular events. Treatment of PAD is based on lifestyle modifications; regular exercise; smoking cessation; and control of cardiovascular risk factors, including hypercholesterolemia. A growing number of studies have shown that statins reduce cardiovascular risk and improve symptoms associated with PAD. Current guidelines recommend the use of statins in all patients with PAD in order to decrease cardiovascular events and mortality. However, the prescribing of statins in patients with PAD is lower than in those with coronary heart disease. This review provides relevant information from the literature that supports the use of statins in patients with PAD and shows their potential benefit in decreasing lower limb complications as well as cardiovascular morbidity and mortality.

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Preoperative statin therapy is associated with higher 5-year survival after thoracic endovascular aortic repair

Allar

Swerdlow

Guerre

et al. 2021

Journal of Vascular Surgery

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The prescription of best medical therapy following infrainguinal bypass grafting in Australia and New Zealand: a multicentre Australasian audit

Abstract: This article is an audit across five hospitals in Australia and New Zealand of 688 infrainguinal bypass operations, looking at which patients were discharged on appropriate medical therapy post‐operatively. It highlights a large gap in clinical care across Australia and New Zealand.

Cited by 4 publications

References 25 publications

The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

Statins and Peripheral Arterial Disease: A Narrative Review

Preoperative statin therapy is associated with higher 5-year survival after thoracic endovascular aortic repair

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