The Quality and Impact of Risk Factor Control in Patients With Stable Claudication Presenting for Peripheral Vascular Interventions

Abstract

Background— Peripheral arterial disease is a manifestation of systemic atherosclerosis and is predictive of future cardiovascular events. Clinical trial data have demonstrated that medical therapy can attenuate cardiovascular morbidity and mortality in patients with peripheral arterial disease. The utilization and impact of recommended medical therapy in a contemporary population of patients who undergo percutaneous interventions for lifestyle-limiting peripheral arterial disease is unknown. Methods and Results— Using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention (BMC2 PVI) database, we identified 1357 peripheral vascular intervention encounters between January 2007 and December 2009 for the purpose of treating claudication. Before the intervention, 85% of these patients used aspirin, 76% used statin, 65% abstained from smoking, and 47% did all 3. There was no difference in cardiovascular events among those taking an aspirin and a statin on admission and those who were not. However, in both an unadjusted and a multivariable analysis, the odds of an adverse peripheral vascular outcome (repeat peripheral intervention, amputation, or limb salvage surgery) within 6 months decreased by more than half in patients receiving aspirin and statin therapy before peripheral vascular intervention as compared with those who received neither (odds ratio, 0.45; 95% CI, 0.29–0.71). Conclusions— The fundamental elements of medical therapy in patients with lifestyle-limiting claudication are often underutilized before referral for revascularization. Appropriate medical therapy before percutaneous revascularization is associated with fewer peripheral vascular events at 6 months.

If not now, when? Prescription of evidence-based medical therapy prior to hospital discharge increases utilization at 6 months in patients with symptomatic peripheral artery disease

“…We have previously shown that prescription of EBMT prior to percutaneous revascularization is associated with fewer peripheral vascular events at 6 months, including fewer repeat PVI procedures. 15 Programs such as the American College of Cardiology's Guidelines Applied in Practice (GAP) project and Get with the Guidelines (GWTG) program have been shown to improve adherence to EBMT in CAD patients. The GAP project is a multifaceted intervention that created systems and guideline-based tools to increase adherence to EBMT for patients with an acute myocardial infarction.…”

Quality of care among patients undergoing lower extremity revascularization

“…13 The use of risk factor modification in patients with symptomatic PAD who undergo LER is also low. 8,11,18 Conte and colleagues examined the medical therapy provided to 1403 patients who underwent infrainguinal bypass for critical limb ischemia as part of the PREVENT III trial. 8 On admission, 67% were taking an antiplatelet and 46% a lipid-lowering agent.…”

“…Ardati and colleagues found that users of aspirin and statins had decreased peripheral intervention, limb salvage surgery, and amputation at six months, but no difference in death, myocardial infarction, and stroke. 11 Patients in that study were treated for claudication and followed for a relatively short duration. Armstrong and colleagues reported that PAD patients with claudication (44%) or critical limb ischemia (56%) who underwent angiography and met all four guideline-based therapies experienced decreased major adverse events compared with patients who receive fewer than four recommended therapies.…”

“…11 The gap between ACCF/AHA guidelines and practice for PAD remains larger than the gap for other cardiovascular diseases (CVDs). 12,13 However, the relationship between these QoC measures and outcomes in patients with PAD is not as well established as it is for other CVDs.…”

Outpatient Follow-Up of the Lower Extremities Atherosclerosis Patients From Cardiologist Point of View

“…При анализе факторов, ассоциированных с приемом комбинированной терапии, таковыми оказались: наличие сопутствующей ИБС, сахар-ного диабета, предшествующая реваскуляризация по поводу ОЗАНК [4,15] и число факторов риска не менее трех [4]. Напротив, наличие критической ише-мии нижних конечностей не влияло на частоту назна-чения кардиоваскулярной протективной терапии [4], что согласуется с нашими данными -группы с раз-личной выраженностью ОЗАНК не различались по частоте назначения препаратов.…”