Organising a nurse-driven PAD rehabilitation clinic within the vascular surgical department: what is required and are treatment goals reached--a prospective study?
OBJECTIVE
Patients with PAD may have severe symptoms from their lower extremities as well as a 3-4 fold increased risk of death due to systemic atherosclerosis. The purpose of this study was to identify whether treatment goals of a nurse led rehabilitation clinic were achieved.


METHODS
Prospective cohort study over 4 year period to May 2004.


METHODS
All patients with symptomatic PAD were offered enrollment in a nurse-led rehabilitation clinic and given advice on diet and exercise. All smokers were offered smoking cessation advice and treatment. Anti-platelet therapy was prescribed to all patients and statin therapy was prescribed to those with dyslipidemia.


RESULTS
693 patients with symptomatic PAD were prospectively entered into the clinic (total 2563 clinic visits). Average age was 67 years and 53% were males. Some (167, 24%) were included for non-surgical treatment and most (526, 76%) were included as part of their postoperative follow-up. After 6 months, the proportion of patients taking platelet inhibitors and statins had increased from 63% and 27% to 87% and 84% respectively. Mean total cholesterol was reduced from 6.2 mmol/l to 4.9 mmol/l and mean LDL cholesterol from 3.9 mmol/l to 2.6 mmol/l. After 1 year the proportion of smokers was reduced from 59% to 51.5% (12.5% relative reduction).


CONCLUSIONS
This nurse-driven rehabilitation clinic has proven effective in reaching medication targets for secondary prevention. Smoking cessation was less successful.
Sillesen
H
H
Department of Vascular Surgery, Rigshospitalet, Denmark. henrik.sillesen@rh.dk
Madelung
S
S
Eldrup
N
N
Roed
M
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D016491:Peripheral Vascular Diseases / Q000188:drug therapy / Q000451:nursing* / Q000534:rehabilitation* / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016540:Smoking Cessation; D013503:Surgery Department, Hospital; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors