Missed opportunities to treat atherosclerosis in patients undergoing peripheral vascular interventions: Insights from the University of Michigan peripheral vascular disease quality improvement initiative (PVD-QI2)

Debabrata Mukherjee, Prasanth Lingam, Stanley Chetcuti, P. Michael Grossman, Mauro Moscucci, Ann E. Luciano, Kim A. Eagle

Research output: Contribution to journalArticle

117 Scopus citations

Abstract

Background - Peripheral vascular disease is a manifestation of systemic atherosclerosis and is associated with an increased risk of cardiovascular morbidity and mortality. Methods and Results - We examined clinical outcomes in 66 consecutive patients undergoing peripheral vascular interventions at our institution between January 2001 and October 2001. At hospital discharge and at 6 months, lifestyle modifications and use of evidence-based therapy was suboptimal. At 6 months, a significant proportion continued to smoke (22.7%) and only half of the patients exercised, controlled their weight, or modified their diet for lipid control. The use of antiplatelet therapy was 77.2%; of angiotensin-converting enzyme, 35.9%; of β-blockers, 42.5%; and of statins, 50%. Twelve of the 66 patients (18.2%) had a clinical event of death, myocardial infarction, or stroke. An appropriateness algorithm for use of secondary prevention measures was created with the use of evidence-based therapy guidelines, and a composite appropriateness variable was also created. The use of evidence-based therapy was associated with a significant reduction of the composite of death, myocardial infarction, and stroke at 6 months (OR 0.02, 95% CI 0.01 to 0.44, P=0.01). Conclusions - Atherosclerosis risk factors are very prevalent in patients with peripheral vascular disease, but these patients receive less than optimal treatment after a predominantly technical vascular intervention. Effective secondary prevention with appropriate lifestyle interventions and evidence-based medical therapy needs to be strongly encouraged and implemented in these patients.

Original languageEnglish (US)
Pages (from-to)1909-1912
Number of pages4
JournalCirculation
Volume106
Issue number15
DOIs
StatePublished - Oct 8 2002

Keywords

  • Atherosclerosis
  • Hypertension
  • Peripheral vascular disease
  • Risk factors

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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