Guideline-Directed Medical Therapy and Long-Term Mortality and Amputation Outcomes in Patients Undergoing Peripheral Vascular Interventions

Smolderen, Kim G.; Romain, Gaëlle; Provance, Jeremy; Scierka, Lindsey; Mao, Jialin; Goodney, Phillip; Henke, Peter K.; Sedrakyan, Art; Mena‐Hurtado, Carlos

doi:10.1016/j.jcin.2022.09.022

Cited by 10 publications

(4 citation statements)

References 39 publications

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“…The study revealed that a significant proportion, approximately 50%, of these patients were not being administered guideline-directed medical therapy (GDMT) as recommended by established clinical guidelines. Individuals who did not receive GDMT exhibited a markedly elevated susceptibility to mortality and amputation, as indicated by previous research [19].…”

Section: Discussionsupporting

confidence: 60%

Preventing Peripheral Arterial Disease: The Crucial Role of Cardiologists.

Kumar

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Peripheral artery disease (PAD) is a clinical appearance of systemic atherosclerotic disease. Individuals diagnosed with PAD exhibit an unfavorable prognosis characterized by an elevated susceptibility to cardiovascular (CV) occurrences, such as stroke, myocardial infarction, limb ischemia, and cardiovascular mortality. Consequently, the timely identification and management of PAD assume paramount significance. PAD and CAD (coronary artery disease) exhibit a shared pathogenesis and risk elements, thereby conferring upon cardiologists a distinct advantage in the screening, diagnosis, and management of PAD. Furthermore, PAD and CAD exhibit overlapping treatment objectives, which encompass a proactive alteration of risk elements to mitigate the likelihood of cardiovascular events. PAD continues to be a condition that is frequently overlooked in terms of diagnosis and treatment, resulting in potential legal ramifications within the medical field. The objective of this review is to raise alertness among clinicians concerning the importance of PAD, as the responsibilities of cardiologists continue to broaden. Recognizing the systemic nature of PAD and its association with adverse cardiovascular outcomes underscores the importance of early diagnosis and proactive management. Future research, interdisciplinary collaboration, and policy development should all aim to improve the identification and care of individuals with PAD, ultimately reducing the burden of cardiovascular events and enhancing patient care.

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Section: Discussionsupporting

confidence: 60%

Preventing Peripheral Arterial Disease: The Crucial Role of Cardiologists.

Kumar

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“…A recent large observational study enrolling 15,891 patients with LE-PAD undergoing peripheral vascular intervention revealed that almost one-half of patients were not on GDMT. The mortality risk was higher among patients who did not receive GDMT versus those who did (31.2% vs. 24.5%; HR: 1.37; 95% CI: 1.25–1.50; p < 0.001), as well as the risk of amputation (16.0% vs. 13.2%; HR: 1.20; 95% CI: 1.08–1.35; p < 0.001) [ 93 ]. These data highlight the need to incorporate ABI in the routine clinical practice of a number of different medical and affiliated specialists for the early diagnosis of LE-PAD, and also the need for a greater awareness for the best medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Focus on Prevention: Peripheral Arterial Disease and the Central Role of the Cardiologist

Fioretti

Gerardi

Giugliano

et al. 2023

JCM

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Peripheral artery disease (PAD) is a manifestation of systemic atherosclerotic disease. PAD patients have a poor prognosis with an increased risk of cardiovascular (CV) events, including myocardial infarction (MI), stroke, limb ischemia and CV death; therefore, it is important to detect and treat PAD early. PAD and coronary artery disease (CAD) share a common pathogenesis and risk factors for development; therefore, cardiologists are in a unique position to screen, diagnosis and treat PAD. Moreover, PAD and CAD also share some treatment goals, including an aggressive modification of risk factors to reduce the risk of CV events. However, PAD remains an underdiagnosed and undertreated disease with medico-legal implications. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinicians to the significance of PAD.

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“…52,55,59 These risks of ischemic events, amputation, and mortality after revascularization remain high, especially in those who are not optimized on GDMT with reports finding that fewer than two-thirds of patients are discharged on statins and only 48.8% on GDMT. 63,64 Furthermore, addressing comorbidities including smoking cessation, DM, and renal insufficiency are important in reducing MALE-related hospitalizations. 63 Antithrombotic therapy requirements differ in patients with PAD after revascularization because they are at a high risk of requiring re-intervention.…”

Section: Revascularizationmentioning

confidence: 99%

A Practical Guide to Understanding and Treating Peripheral Artery Disease

Chilbert,

Woodruff,

Rogers

2024

Journal of Cardiovascular Pharmacology

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Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic morbidity after coronary heart disease and stroke yet is widely underdiagnosed and undertreated. Treatment of risk factors such as diabetes and cigarette smoking can benefit patients with PAD. Patients should have adequate blood pressure and lipid control to decrease clinical manifestations and symptoms of PAD. Use of antithrombotic medications should be individualized to the patient depending on presence of symptoms, revascularization, and comorbidities. All patient care providers, including physicians, pharmacists, nurse practitioners, and physician assistants should incorporate PAD screening in their at-risk patients to improve access for appropriate earlier diagnosis, initiation of guideline directed therapy, and risk factor modification in order to reduce both major adverse CV and limb outcomes. The purpose of this narrative review is to provide an overview of PAD, summarize clinical trial evidence and guideline recommendations for screening and treatment in order to increase awareness among health care providers to ultimately have a positive impact on patient care.

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Guideline-Directed Medical Therapy and Long-Term Mortality and Amputation Outcomes in Patients Undergoing Peripheral Vascular Interventions

Cited by 10 publications

References 39 publications

Preventing Peripheral Arterial Disease: The Crucial Role of Cardiologists.

Preventing Peripheral Arterial Disease: The Crucial Role of Cardiologists.

Focus on Prevention: Peripheral Arterial Disease and the Central Role of the Cardiologist

A Practical Guide to Understanding and Treating Peripheral Artery Disease

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