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Effect of Guideline Orientation on the Outcomes of Peripheral Arterial Disease in Primary Care
(2011)
Peripheral arterial disease (PAD), an established marker of premature death and cardiovascular risk in general, is highly prevalent. We analysed factors associated with poor outcomes in an observational cohort, with particular focus on the effect of guideline orientation in the management of these patients.
Arzneimittelversorgung
(2013)
Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in
general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not.
Methods. PACE-PAD was a multicentre, cluster - randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of
diabetes mellitus, hypertension, or hypercholesterolemia, respectively.
Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5%
(1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not.
Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and non-guideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.