Guideline-based care underused for PAD, study says
Interventions to optimize secondary prevention, such as physician note “checklists” or other systematic prescription programs, might improve medication use and lifestyle counseling.
Physicians offer guideline-recommended medical therapy and lifestyle counseling for patients with peripheral artery disease (PAD) less frequently than expected, a study found.
Researchers evaluated trends in both medical therapy and lifestyle counseling for PAD patients by looking at data from 1,982 outpatient visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2005 through 2012. Trends were examined for medication use (antiplatelet therapy, statins, angiotensin-converting enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and cilostazol), and lifestyle counseling (exercise or diet counseling and smoking cessation). Results were published online May 1 by the Journal of the American College of Cardiology.
The estimated number of annual visits for PAD in the United States increased from 2.7 million (95% CI, 1.9 to 3.5 million) in 2006 to 3.4 million (95% CI, 2.4 to 4.4 million) in 2013. The overall prevalence of a PAD diagnosis in adults in the dataset was 0.4%.
The proportion of visits with reported use of antiplatelet therapy was 36.3% in 2006 to 2007 and 39.7% in 2012 to 2013, with no significant change over time (P=0.59 for trend). Neither aspirin nor clopidogrel use changed over time. Dual antiplatelet therapy with aspirin plus clopidogrel was infrequent (7.3% in 2006 to 2007 to 7.1% in 2012 to 2013; P=0.38 for trend).Medication use for cardiovascular prevention and symptoms of claudication was low: any antiplatelet therapy in 35.7% (standard error [SE], 2.7%), statins in 33.1% (SE, 2.4%), ACE inhibitor/ARB in 28.4% (SE, 2.0%), and cilostazol in 4.7% (SE, 1.0%) of visits.
Exercise or diet counseling was used in 22% (SE, 2.3%) of visits. The proportion of patient visits with reported exercise or diet counseling did not change over time (18% in 2006 to 2007 and 12.7% in 2012 to 2013; P=0.23 for trend). Among smokers, smoking cessation counseling or pharmacotherapy was offered in 36.2% of visits, and this did not change over time (36.8% in 2006 to 2007 and 38.7% in 2012 to 2013; P=0.96 for trend).
The treatment gap highlights an opportunity to improve the quality of care in these high-risk patients, the study authors concluded.
“Although we are unable to determine the reason for the underuse of secondary prevention and lifestyle counselling, interventions to optimize secondary prevention, such as physician note ‘checklists' or other systematic prescription programs, would likely improve medication use and lifestyle counselling,” the authors wrote.
An editorial stated that it was “difficult to explain these rather alarming results of undertreatment in PAD patients.” The editorial called for national societies to increase physician and patient awareness, health care systems to have metrics for PAD care, and vascular specialists to increase collaboration of care.