Document Detail

Medication underuse during long-term follow-up in patients with peripheral arterial disease.
MedLine Citation:
PMID:  20031859     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with peripheral arterial disease constitute a high-risk population. Guideline-recommended medical therapy use is therefore of utmost importance. The aims of our study were to establish the patterns of guideline-recommended medication use in patients with PAD at the time of vascular surgery and after 3 years of follow up, and to evaluate the effect of these therapies on long-term mortality in this patient group. METHODS AND RESULTS: Data on 711 consecutive patients with peripheral arterial disease undergoing vascular surgery were collected from 11 hospitals in the Netherlands (enrollment between May and December 2004). After 3.1+/-0.1 years of follow-up, information on medication use was obtained by a questionnaire (n=465; 84% response rate among survivors). Guideline-recommended medical therapy use for the combination of aspirin and statins in all patients and beta-blockers in patients with ischemic heart disease was 41% in the perioperative period. The use of perioperative evidence-based medication was associated with a reduction of 3-year mortality after adjustment for clinical characteristics (hazard ratio, 0.65; 95% CI, 0.45 to 0.94). After 3 years of follow-up, aspirin was used in 74%, statins in 69%, and beta-blockers in 54% of the patients respectively. Guideline-recommended medical therapy use for the combination of aspirin, statins, and beta-blockers was 50%. CONCLUSIONS: The use of guideline recommended therapies in the perioperative period was associated with reduction in long-term mortality in patients with peripheral arterial disease. However, the proportion of patients receiving these evidence-based treatments-both at baseline and 3 years after vascular surgery-was lower than expected based on the current guidelines. These data highlight a clear opportunity to improve the quality of care in this high-risk group of patients.
Sanne E Hoeks; Wilma J M Scholte op Reimer; Yvette R B M van Gestel; Olaf Schouten; Mattie J Lenzen; Willem-Jan Flu; Jan-Peter van Kuijk; Corine Latour; Jeroen J Bax; Hero van Urk; Don Poldermans
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-04-24
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  2     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-12-24     Completed Date:  2010-03-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  338-43     Citation Subset:  IM    
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Aspirin / therapeutic use
Cardiovascular Agents / therapeutic use*
Drug Therapy, Combination
Evidence-Based Medicine / statistics & numerical data
Follow-Up Studies
Guideline Adherence / statistics & numerical data*
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Middle Aged
Myocardial Ischemia / drug therapy,  mortality
Peripheral Vascular Diseases / drug therapy*,  mortality*
Platelet Aggregation Inhibitors / therapeutic use
Practice Guidelines as Topic
Risk Factors
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Cardiovascular Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

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