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

• Published in: European journal of vascular and endovascular surgery Vol. 33; no. 4; pp. 442 - 450
• Main Authors: Khan, S, Flather, M, Mister, R, Delahunty, N, Fowkes, G, Bradbury, A, Stansby, G
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2007
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities - statistics & numerical data; Antihypertensive Agents - therapeutic use; Antiplatelet agents; Benchmarking; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Claudication; Cohort Studies; Female; General practice; Health Knowledge, Attitudes, Practice; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypercholesterolemia - complications; Hypercholesterolemia - drug therapy; Hypertension - complications; Hypertension - drug therapy; Intermittent Claudication - drug therapy; Intermittent Claudication - etiology; Male; Middle Aged; Peripheral arterial disease; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - drug therapy; Peripheral Vascular Diseases - etiology; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Prospective Studies; Referral and Consultation - statistics & numerical data; Registries - statistics & numerical data; Risk Factors; Secondary Prevention; Smoking; Smoking - adverse effects; Smoking Cessation - statistics & numerical data; Surgery; United Kingdom - epidemiology; Peripheral arterial disease; Claudication; General practice; Risk factors; Antiplatelet agents; Smoking
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2006.11.010

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.