Risk-Reduction Program for Cardiovascular and Limb Events in Patients With Peripheral Arterial Disease

JAMA Surgery ◽  
2016 ◽  
Vol 151 (10) ◽  
pp. 990
Author(s):  
Tomoyuki Kawada
Keyword(s):  
Peripheral Arterial Disease ◽  
Risk Reduction ◽  
Arterial Disease ◽  
Reduction Program ◽  
Peripheral Arterial

Efficacy of a Guideline-Recommended Risk-Reduction Program to Improve Cardiovascular and Limb Outcomes in Patients With Peripheral Arterial Disease

JAMA Surgery ◽  
2016 ◽  
Vol 151 (8) ◽  
pp. 742 ◽  
Author(s):  
Mohamad A. Hussain ◽  
Mohammed Al-Omran ◽  
Muhammad Mamdani ◽  
Naomi Eisenberg ◽  
Azra Premji ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Risk Reduction ◽  
Arterial Disease ◽  
Reduction Program ◽  
Peripheral Arterial

Abstract 12428: Efficacy of a Risk Reduction Program to Improve Cardiovascular Outcomes in Patients With Peripheral Arterial Disease: A Propensity Score-Matched Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohamad A Hussain ◽  
Mohammed Al-Omran ◽  
Muhammad Mamdani ◽  
Xuesong Wang ◽  
Subodh Verma ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Propensity Score ◽  
Peripheral Arterial Disease ◽  
Risk Reduction ◽  
Primary Outcome ◽  
Arterial Disease ◽  
Reduction Program ◽  
Peripheral Arterial

Introduction: Patients with peripheral arterial disease (PAD) are often undertreated for cardiovascular (CV) risk factors, and they are at high risk for CV events. Hypothesis: A program that focuses on guideline-based risk factor management reduces adverse CV and limb events in PAD patients. Methods: A propensity-score matched observational cohort study with up to 7 years of follow-up was conducted using administrative databases in Ontario, Canada. Symptomatic PAD patients that were enrolled in the Systematic Assessment of Vascular Risk (SAVR) program between July 2004 and April 2007 were matched with up to 2 (control) patients with PAD from other Ontario tertiary vascular centers not enrolled in the program. The primary outcome was a composite of death, stroke or myocardial infarction (MI). Secondary outcomes included lower limb amputation and revascularization procedures. Cox proportional hazards regression analysis was used to compare outcomes between the groups. Results: A total of 791 patients were studied. During follow-up, the SAVR group (n=290) experienced the primary outcome at a significantly lower rate than the control group (adjusted HR, 0.64 [95% CI, 0.52 to 0.78]; P<0.001) (Figure). SAVR patients were also less likely to undergo major amputation (adjusted HR, 0.47 [95% CI, 0.29 to 0.77]; P=0.002), minor amputation (adjusted HR, 0.26 [95% CI, 0.13 to 0.54]; P<0.001), arterial bypass surgery (adjusted HR, 0.47 [95% CI, 0.30 to 0.73]; P<0.001), and less likely to have a hospitalization due to heart failure (adjusted HR, 0.73 [95% CI, 0.53 to 0.998]; P=0.048). The rate of peripheral angioplasty was higher among the SAVR group (adjusted HR, 3.0 [95% CI, 2.2 to 4.1]; P<0.001). Conclusions: A multifactor risk reduction program targeted to patients with PAD is associated with fewer adverse CV and limb events over the long-term. Greater focus is needed on developing structured programs for risk factor control in these high-risk patients.

Perceptions of Canadian Vascular Surgeons toward Pharmacological Risk Reduction in Patients with Peripheral Arterial Disease

2006 ◽  
Vol 20 (5) ◽  
pp. 555-563 ◽  
Author(s):  
Mohammed Al-Oniran ◽  
Thomas F. Lindsay ◽  
Jennifer Major ◽  
Ali Jawas ◽  
Larry A. Leiter ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Risk Reduction ◽  
Arterial Disease ◽  
Peripheral Arterial

Abstract 056: Age-specific Differences in Baseline Characteristics, Peripheral Arterial Disease Specific Health Status, and Patterns of Care in Patients With Peripheral Arterial Disease: Insights From the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) Registry

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David Halpin ◽  
Erica Spatz ◽  
Bennet Cua ◽  
Sunny Jhamnani ◽  
Kim Smolderen ◽  
...  
Keyword(s):  
Health Status ◽  
Peripheral Arterial Disease ◽  
Risk Reduction ◽  
Arterial Disease ◽  
Trend Test ◽  
Age Cohorts ◽  
Age Related ◽  
Peripheral Arterial ◽  
Specific Health

Background: The aging population along with the increased use of statins, anti-platelet agents, supervised exercise (SE) and smoking cessation (SC) may be altering the epidemiology of peripheral arterial disease (PAD) and may be delaying its onset. There are no insights into how older versus younger patients differ in terms of PAD severity, risk profiles, health status and treatment. We hypothesized that in the absence of any reliable age-related differences in treatment effectiveness, that risk reduction and revascularization would be used equally across PAD age cohorts. Aim: Assess age-specific differences in baseline characteristics, PAD-specific health status, and patterns of care in patients in the PORTRAIT registry. Methods: The PORTRAIT registry prospectively collected data from 1275 patients with new or worsening PAD symptoms who were treated in the US, the Netherlands or Australia between June 2011 and October 2015. Patients were grouped by age (< 60 years, 60 to ≤75 years, and > 75 years). We compared patient characteristics at the point of seeking specialty PAD care, including severity of PAD (Rutherford classification); health status assessed by the Peripheral Artery (PAQ) and EuroQol five dimensions (EQ5D) questionnaires; and subsequent clinical care offered for PAD, including statins, anti-platelet agents, SE, and SC. The use of revascularization (surgical or endovascular) was assessed at 3 months. Continuous variables were compared using the linear trend test. Categorical variables were compared using Mantel-Haenszel trend test. Results: There were 303 patients < 60 years (mean 55.0 ± 4.3), 675 patients 60 to ≤75 years (mean 67.8 ± 3.9), and 297 patients ≥ 75 years (mean 79.9 ± 4.1). There were no differences in baseline ABI (mean 0.66 ± 0.2, p=0.44) or Rutherford classification (p=0.47). PAQ summary, quality of life, social limitation, and symptom scores as well as EQ5D scores were significantly worse in patients < 60 years (p<0.001 for all indicators). Patients < 60 years were more likely to be current smokers (60.9% vs. 35.4%, vs. 17.5%, p<0.001). Risk reduction and quality of life (QOL) improvement PAD treatments that were comparable across age cohorts included: statins (p=0.10), SC (0.17), and referral for invasive therapy (p=0.34). In contrast, SE was prescribed more in patients < 60 years (p< 0.001) while anti-platelet therapy was used less often in this group (p=0.025). Conclusion: These data demonstrate that younger patients are characterized by worse PAD-specific health status at the time of entry into vascular specialty care and that there are age-related disparities in the prescription of PAD risk reduction and QOL improvement therapies. These data cannot document the reasons for these differences. Future quality improvement initiatives might focus on these disparities in presentation and care to improve outcomes in PAD.

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