Multi-Centre Study on Cardiovascular Risk Management on Patients Undergoing AAA Surveillance

Saratzis, Athanasios; Dattani, Nikesh; Brown, Amy; Shalhoub, Joseph; Bosanquet, David C.; Sidloff, David; Stather, P.W.

doi:10.1016/j.ejvs.2017.04.009

Cited by 27 publications

(30 citation statements)

References 29 publications

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“…In this study of ten vascular centres in the UK the medical management of patients with PAD was suboptimal. Previous studies by VERN in the UK had highlighted that cardiovascular risk management in patients with aneurysms is suboptimal. Most patients in the present series were hyperlipidaemic and hypertensive.…”

Section: Discussionmentioning

confidence: 99%

Observational study of the medical management of patients with peripheral artery disease

Saratzis

Jaspers

Gwilym

et al. 2019

British Journal of Surgery

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Background Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target‐based risk factor modification. Methods The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal‐directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART‐REACH model, a validated cardiovascular prediction tool for patients with PAD. Results Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL‐cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high‐dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44–62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL‐cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10‐year cardiovascular risk by 29 (20–38) per cent with 6·3 (4·0–9·3) cardiovascular disease‐free years gained. Conclusion The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline‐based targets would confer significant patient benefit.

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Section: Discussionmentioning

confidence: 99%

Observational study of the medical management of patients with peripheral artery disease

Saratzis

Jaspers

Gwilym

et al. 2019

British Journal of Surgery

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“…Although rate of prescriptions for antiplatelet and statin agents are improving for patients with abdominal aortic aneurysm, 16 previous work by VERN has shown that those under aneurysm surveillance also have poor uptake of best medical therapy, 36 suggesting that both primary and secondary care must improve further. Future work must evaluate patient compliance in the long term with reducing cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work by VERN has highlighted that advice given to patients on abdominal aortic aneurysm surveillance programmes is insufficient, with only 66% of patients given full cardiovascular risk reduction advice and only 82% of surveillance units advising changes to the patient's prescription. 36 Further work is required to determine uptake of this advice and compliance in the longer term.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular risk reduction in referrals to outpatient vascular clinics

Stather

Muscara

2018

annals

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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

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“…Its multidisciplinary structure fosters close links between trainee surgeons, nurses and vascular scientists on a national basis. VERN has successfully delivered several multi-centre audits without incurring cost using this collaborative approach [14], [15], [16].…”

Section: Introductionmentioning

confidence: 99%

Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study

Gwilym

Saratzis

Benson

et al. 2019

International Journal of Surgery Protocols

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IntroductionSurgical site infections (SSIs) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units’ practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres.Methods and analysisThis international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according to the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer.Ethics and disseminationThis study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.

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Multi-Centre Study on Cardiovascular Risk Management on Patients Undergoing AAA Surveillance

Abstract: Background

Cited by 27 publications

References 29 publications

Observational study of the medical management of patients with peripheral artery disease

Observational study of the medical management of patients with peripheral artery disease

Cardiovascular risk reduction in referrals to outpatient vascular clinics

Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study

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