Atherosclerotic risk factor reduction in peripheral arterial diseasea: results of a national physician survey.
OBJECTIVE
Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD.


METHODS
National physician survey.


METHODS
General internists (N = 406), family practitioners (N = 435), cardiologists (N = 473), and vascular surgeons (N = 264) randomly identified using the American Medical Association's physician database.


RESULTS
Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians "almost always" initiated lipid-lowering drugs were 121.6 +/- 23.5 mg/dL, 136.3 +/- 28.9 mg/dL, and 149.7 +/- 24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (P <.001). Physicians stated that antiplatelet therapy (P <.001) and cholesterol-lowering therapy (P <.001) were extremely important significantly more often for the CAD than for the PAD patient. Perceived importance of risk factor interventions was highly correlated with practice behavior. Compared to other specialties, cardiologists had lowest thresholds, whereas vascular surgeons had the highest thresholds for initiating cholesterol-lowering interventions for the patient with PAD. Cardiologists were significantly more likely to report "almost always" prescribing antiplatelet therapy for the patient with PAD than were all other physicians.


CONCLUSIONS
Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.
McDermott
Mary McGrae
MM
Departments of Medicine and Preventive Medicine, The Feinberg School of Medicine, Northwestern University, Evanston Ill 60611, USA. mdm608@nortwestern.edu
Hahn
Elizabeth A
EA
Greenland
Philip
P
Cella
David
D
Ockene
Judith K
JK
Brogan
Donna
D
Pearce
William H
WH
Hirsch
Alan T
AT
Hanley
Kendra
K
Odom
Linda
L
Khan
Shaheen
S
Criqui
Michael H
MH
Lipsky
Martin S
MS
Hudgens
Stacie
S
D000328:Adult; D001161:Arteriosclerosis / Q000150:complications / Q000517:prevention & control*; D002983:Clinical Competence; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control