Meeting AHA/ACC secondary prevention goals in a vascular surgery practice: an opportunity we cannot afford to miss.
OBJECTIVE
In an effort to reduce cardiovascular mortality, patients with atherosclerotic arterial disease should undergo risk factor modification according to the American Heart Association/American College of Cardiology (AHA/ACC) Secondary Prevention Guidelines (hereafter, Guideline). We assessed compliance with the Guideline in a group of patients seen in a vascular surgery practice.


METHODS
We evaluated 200 consecutive patients with lower-extremity occlusive disease, cerebrovascular disease, or abdominal aortic aneurysm seen by a university-based vascular surgery practice. The subjects were patients who had been seen previously in our clinic (ESTABLISHED) and new referrals (NEW). Data pertinent to each of the nine AHA/ACC Guideline goals were collected from patient interviews, medication histories, and laboratory records. Compliance with each of the Guideline goals was evaluated. Differences in compliance between ESTABLISHED and NEW patient groups were also compared. We also recorded whether a patient had a previous endovascular or open surgical vascular intervention (EVENT or NO EVENT). Differences in compliance between the EVENT and NO EVENT groups were compared.


RESULTS
Most patients did not achieve the secondary prevention goals recommended in the Guideline. Patients who had a prior vascular intervention (EVENT) were significantly more likely to achieve goals for low-density lipoprotein level (43% vs 23%), and for statin (71% vs 39%), beta-blocker (46% vs 27%), angiotensin-converting enzyme inhibitor (53% vs. 35%), and antiplatelet agent (85% vs. 68%) use (P < .05). ESTABLISHED patients were significantly more likely than NEW patients to have a prior EVENT (87% vs 47%, P < .0005). ESTABLISHED patients were significantly more likely than NEW patients to achieve goals for low-density lipoprotein level, beta-blocker, and statin use; however, these differences were likely due to the higher proportion of EVENT patients in the ESTABLISHED group.


CONCLUSIONS
Compliance with the Guideline is suboptimal in patients with atherosclerotic arterial disease. Secondary prevention goals were more often achieved in the EVENT patient group, suggesting that a vascular intervention may lead to increased patient and physician awareness and compliance with the Guideline. A targeted effort towards risk factor modification in patients with atherosclerotic arterial disease could improve compliance with the Guideline and reduce cardiovascular mortality.
Kinikini
Daniel
D
Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City 84132-2301, USA.
Sarfati
Mark R
MR
Mueller
Michelle T
MT
Kraiss
Larry W
LW
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery; D001161:Arteriosclerosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000592:standards; D011322:Primary Prevention / Q000592:standards*; D011336:Probability; D011379:Prognosis; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000379:methods / Q000592:standards*