A cross sectional survey of secondary prevention measures in patients with peripheral arterial disease in primary care

Peripheral arterial disease is a marker of severe atherosclerosis with a significantly higher risk of cardiovascular morbidity and mortality. It is often underdiagnosed and undertreated. Public and patients’ perception of peripheral arterial disease is influenced by their knowledge of the condition. In this study, we aimed to evaluate the Saudi public’s knowledge of peripheral arterial disease and its specific characteristics. We conducted an interview-based cross-sectional survey, and collected data on basic demographics, self-reported peripheral arterial disease awareness, and knowledge of clinical features, risk factors, preventative measures, management strategies, and potential complications of peripheral arterial disease. A total of 866 participants completed the survey (response rate, 94%); two-thirds were females. Only 295 (34%) of the surveyed participants indicated awareness of peripheral arterial disease. Overall peripheral arterial disease knowledge was low among the “peripheral arterial disease aware” group, particularly in the clinical features domain. Age > 40 years, female gender, and higher education were predictors of self-reported awareness of peripheral arterial disease. In conclusion, the Saudi public is largely unaware of peripheral arterial disease. Educational programs are important to address this critical knowledge gap.

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Management of patients with peripheral arterial disease in primary care: a cross-sectional study in Germany

International Journal of Clinical Practice ◽

10.1111/j.1742-1241.2010.02337.x ◽

2010 ◽

Vol 64 (7) ◽

pp. 875-884 ◽

Cited By ~ 6

Author(s):

K. Kröger ◽

M. Schwertfeger ◽

D. Pittrow ◽

C. Diehm

Keyword(s):

Primary Care ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Peripheral Arterial

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Primary care screening for peripheral arterial disease: a cross-sectional observational study

British Journal of General Practice ◽

10.3399/bjgp17x689137 ◽

2017 ◽

Vol 67 (655) ◽

pp. e103-e110 ◽

Cited By ~ 6

Author(s):

Jane H Davies ◽

Jonathan Richards ◽

Kevin Conway ◽

Joyce E Kenkre ◽

Jane EA Lewis ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Peripheral Arterial Disease ◽

Public Awareness ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Smoking History ◽

Cross Sectional ◽

Number Needed To Screen ◽

Peripheral Arterial

BackgroundEarly identification of peripheral arterial disease (PAD) and subsequent instigation of risk modification strategies could minimise disease progression and reduce overall risk of cardiovascular (CV) mortality. However, the feasibility and value of primary care PAD screening is uncertain.AimThis study (the PIPETTE study — Peripheral arterial disease In Primary carE: Targeted screening and subsequenT managEment) aimed to determine the value of a proposed primary care PAD screening strategy. Outcomes assessed were: prevalence of PAD and agreement of ankle– brachial index (ABI)-defined PAD (ABI ≤0.9) with QRISK®2-defined high CV risk (≥20).Design and settingA cross-sectional observational study was undertaken in a large general practice in Merthyr Tydfil, Wales.MethodIn total, 1101 individuals with ≥2 pre-identified CV risk factors but no known CV disease or diabetes were invited to participate. Participants underwent ABI measurement and QRISK2 assessment, and completed Edinburgh Claudication Questionnaires.ResultsA total of 368 people participated in the study (participation rate: 33%). Prevalence of PAD was 3% (n = 12). The number needed to screen (NNS) to detect one new case of PAD was 31. Refining the study population to those aged ≥50 years with a smoking history reduced the NNS to 14, while still identifying 100% of PAD cases. Of participants with PAD, 33% reported severe lifestyle-limiting symptoms of intermittent claudication that warranted subsequent endovascular intervention, yet had not previously presented to their GP. The QRISK2 score predicted high CV risk in 92% of participants with PAD.ConclusionThe low PAD yield and the fact that QRISK2 was largely comparable to the ABI in predicting high CV risk suggests that routine PAD screening may be unwarranted. Instead, strategies to improve public awareness of PAD are needed.

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High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study

Atherosclerosis ◽

10.1016/s0021-9150(03)00204-1 ◽

2004 ◽

Vol 172 (1) ◽

pp. 95-105 ◽

Cited By ~ 481

Author(s):

Curt Diehm ◽

Alexander Schuster ◽

Jens R. Allenberg ◽

Harald Darius ◽

Roman Haberl ◽

...

Keyword(s):

Primary Care ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Co Morbidity ◽

High Prevalence ◽

Primary Care Patients ◽

Peripheral Arterial

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Are elevated homocysteine plasma levels related to peripheral arterial disease? Results from a cross-sectional study of 6880 primary care patients

European Journal of Clinical Investigation ◽

10.1046/j.1365-2362.2003.01196.x ◽

2003 ◽

Vol 33 (9) ◽

pp. 751-757 ◽

Cited By ~ 31

Author(s):

H. Darius ◽

D. Pittrow ◽

R. Haberl ◽

H. J. Trampisch ◽

A. Schuster ◽

...

Keyword(s):

Primary Care ◽

Peripheral Arterial Disease ◽

Plasma Levels ◽

Arterial Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Primary Care Patients ◽

Peripheral Arterial

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139 Efficacy of Implementation of a Junior Doctors' Teaching Program on The Secondary Prevention of Peripheral Arterial Disease in Vascular Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.375 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Daketsey ◽

M Elkawafi ◽

A Khallaf ◽

R Makar

Keyword(s):

Peripheral Arterial Disease ◽

Secondary Prevention ◽

Statin Therapy ◽

Arterial Disease ◽

Evidence Base ◽

Junior Doctors ◽

Teaching Session ◽

Prescription Practices ◽

Best Medical Therapy ◽

Peripheral Arterial

Abstract Introduction According to NICE Guidelines, the Best medical therapy (BMT) for secondary prevention of peripheral arterial disease includes antiplatelet and statin therapy unless contraindicated. Junior Doctors are usually allocated the job of prescribing patients’ medications. Due to discrepancies in their exposure to vascular surgery in earlier training, we implemented an introductory teaching session for them regarding this BMT and audited the efficacy of this intervention. Method A retrospective review of admission and discharge medications of all vascular ward patients from August 12th to 30th September 2019 was done, and the data was analysed via Excel. Results Out of 127 patients (median age 70), 67% and 64% had antiplatelet and statin medications respectively,while on admission. 1 in each patient cohort was found discharged without either medication. The GP of the patient discharged without antiplatelets was contacted to ensure this was rectified. The other patient had refused statin therapy and thus a discharge note to their GP was conducted to reflect this. Conclusions A teaching session as part of a vascular departmental induction emphasising the evidence base for antiplatelet and statin therapy can contribute to improving prescription practices of junior doctors starting in the department.

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Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-041715 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041715

Author(s):

Aarent RT Brand ◽

Eline Houben ◽

Irene D Bezemer ◽

Frank L J Visseren ◽

Michiel L Bots ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

The Netherlands ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Free Text ◽

Newly Diagnosed ◽

Patient Journey ◽

P2y12 Inhibitors ◽

Peripheral Arterial

ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.

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