Vascular quality of care pilot study: how admission to a vascular surgery service affects evidence-based pharmacologic risk factor modification in patients with lower extremity peripheral arterial disease.
Peripheral arterial disease (PAD) guidelines recommend aggressive risk factor modification to improve cardiovascular outcomes. Recommended pharmacologic therapies include antiplatelets, angiotensin converting enzyme (ACE) inhibitors, and HMG-CoA-reductase inhibitors (statins).
We studied the degree to which patient admission to a vascular surgery service increased the use of these therapies.
The authors conducted a retrospective chart review of 150 patients with PAD admitted to the vascular surgery service at a large Canadian tertiary care hospital. The use of recommended pharmacologic therapies at the time of admission and discharge were compared. A multidisciplinary clinical team established criteria by which patients were deemed ineligible to receive any of the recommended therapies. Angiotensin receptor blockers (ARBs) were considered an alternative to ACE inhibitors.
Prior to hospital admission, 64% of patients were on antiplatelet therapy, 67% were on an ACE inhibitor or ARB, and 71% were on a statin. At the time of discharge, 91% of patients were on an antiplatelet (or not, with an acceptable reason), 77% were on an ACE inhibitor or an ARB (or not, with an acceptable reason), and 85% were on a statin (or not, with an acceptable reason). While new prescriptions were largely responsible for improved guideline adherence with antiplatelets and statins, most of the apparent improvement in ACE inhibitor and ARB use was the result of identifying an acceptable reason for not having them prescribed.
This hypothesis generating pilot study supports the findings of others that there is suboptimal prescription of pharmacologic risk reduction therapies in the PAD population. Admission to a vascular service increases these rates. Nevertheless, some patients are still not receiving evidence-based treatment at discharge even after consideration of acceptable reasons. Strategies are needed to improve PAD guideline adherence in both the community at large and the vascular surgery service.
Cites: Circulation. 1996 Dec 1;94(11):3026-498941154
Cites: Can J Cardiol. 2005 Oct;21(12):997-100616234879
Cites: J Am Coll Cardiol. 2006 Mar 21;47(6):1239-31216545667
Cites: N Engl J Med. 2008 Apr 10;358(15):1547-5918378520
Cites: Can J Cardiol. 2009 Jan;25(1):39-4519148341
Cites: Can J Public Health. 2010 Jan-Feb;101(1):96-10020364548
Cites: Vasc Health Risk Manag. 2011;7:15-2121339909
Cites: J Am Coll Cardiol. 2011 Nov 1;58(19):2020-4521963765
Cites: Can J Cardiol. 2011 May-Jun;27 Suppl A:S1-5921640290