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

Abstract

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.

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.…”

Can a rapid-access vascular limb salvage service improve one-year amputation outcomes for patients with chronic limb-threatening ischaemia?

“…29,30 These prescription rates are comparable to a recent multi-centred, audit of secondary care practice within the UK and further highlight the important need to improve the medical management of patients with CLTI. 31 The study also identified that a significantly higher proportion of patients within the VaLS cohort were managed for neuropathic DFU, compared to both comparator cohorts. This may reflect the close working relationship between loco-regional diabetic foot services and the VaLS clinic, and an increasing tendency to refer patients to the clinic for vascular assessment who may not otherwise be referred.…”

The global impact of the first Coronavirus Disease 2019 (COVID-19) pandemic wave on vascular services

“…The Vascular and Endovascular Research Network (VERN) is an established vascular research collaborative [6][7][8][9] , which responded rapidly to the pandemic by delivering the COVID-19 Vascular SERvice (COVER) study, an international prospective mixedmethodology project. The aim of the first part of the COVER study described here (Tier 1), is to document fluctuations in vascular services globally during the first phase of the pandemic.…”