Characteristics and Treatments of Patients with Peripheral Arterial Disease Referred to UK Vascular Clinics: Results of a Prospective Registry

Autor: R. Mister, Andrew W. Bradbury, Gerard Stansby, Marcus Flather, S. Khan, Gerry Fowkes, N. Delahunty
Jazyk: angličtina
Předmět:
Male
Health Knowledge
Attitudes
Practice
medicine.medical_treatment
Ambulatory Care Facilities
Cohort Studies
Quality of life
Secondary Prevention
Prospective Studies
Registries
Practice Patterns
Physicians'
Prospective cohort study
Referral and Consultation
Medicine(all)
Aged
80 and over
Peripheral Vascular Diseases
Smoking
Antiplatelet agents
Middle Aged
Benchmarking
Cardiovascular Diseases
Hypertension
Practice Guidelines as Topic
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
General practice
Cohort study
Adult
medicine.medical_specialty
Referral
Hypercholesterolemia
MEDLINE
macromolecular substances
Internal medicine
Peripheral arterial disease
medicine
Humans
cardiovascular diseases
Antihypertensive Agents
Aged
business.industry
Intermittent Claudication
United Kingdom
Blood pressure
Risk factors
Physical therapy
Smoking cessation
Smoking Cessation
Surgery
Claudication
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Platelet Aggregation Inhibitors
Zdroj: European Journal of Vascular and Endovascular Surgery. (4):442-450
ISSN: 1078-5884
DOI: 10.1016/j.ejvs.2006.11.010
Popis: Background Peripheral arterial disease (PAD) is often associated with risk factors including cigarette smoking, hypertension and hypercholesterolaemia, and patients have a high risk of future vascular events. Good medical management results in improved outcomes and quality of life, but previous studies have documented sub-optimal treatment of risk factors. We assessed the management of cardiovascular risk factors in patients with PAD referred to specialist vascular clinics. Methods This was a prospective, protocol driven registry carried out in UK vascular clinics. Patients who were first-time referrals for evaluation of PAD were eligible if they had claudication plus ankle-brachial pressure index (ABPI) ≤0.9. Statistical associations between key demographic and treatment variables were explored using a chi-squared test. Results We enrolled 473 patients from 23 sites. Mean age was 68 years (SD 10) and 66% were male. Mean estimated claudication distance was 100 m, and ABPI was 0.74. Mean systolic blood pressure (SBP) was 155 mmHg, and 42% had a SBP >160 mmHg. Forty percent were current smokers and half had tried to give up in the prior 6 months, but there was no evidence of a systematic method of smoking cessation. Mean total cholesterol was 5.4 (SD1.2) mmol/l and 30% had levels >6 mmol/l. Antiplatelet therapy had been given to 70% and statins to 44%. Prior CHD was present in 29% and these patients had significantly higher use of antiplatelet therapy, statins and ACE-inhibitors. Conclusions In spite of attempts to raise awareness about PAD as an important marker of cardiovascular risk, patients are still poorly treated prior to referral to a vascular clinic. In particular, the use of evidence-based treatments is sub-optimal, while hypertension and cigarette smoking are poorly managed. More work needs to be done to educate health professionals about the detection and optimal medical management of PAD.
Databáze: OpenAIRE
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