Secondary medical prevention in patients with peripheral arterial disease - prescriptions of vascular surgeons and medical doctors (angiologists) in a multidisciplinary vascular centre.
BACKGROUND
We compared medical secondary prevention in patients with peripheral arterial disease stage II (Fontaine) located in the femoro-popliteal artery managed by vascular surgeons and medical doctors / angiologists in our multidisciplinary vascular center.


METHODS
We retrospectively analyzed demission protocols of in-hospital treatments between 01.01.2007 and 20.06.2008.


RESULTS
We surveyed 264 patients (54.2 % women; mean age 67.52 +/- 8.98 yrs), 179 (67.8 %) primarily treated by medical doctors / angiologists and 85 (32.2 %) primarily managed by vascular surgeons. Medical doctors / angiologists treated more women (n = 109) than men (n = 34), (p = 0.002) and documented smoking and diabetes mellitus more often (p < 0.001) than vascular surgeons. Besides, patients had similar cardiovascular risk profiles and concomitant diseases, vascular surgeons prescribed 5.47 +/- 2.26 drugs, medical doctors / angiologists 6.37 +/- 2.67 (p = 0.005). Overall, 239 (90.5 %) patients were on aspirin, 180 (68.2 %) on clopidogrel, and 18 (6.9 %) on oral anticoagulants. Significantly more patients treated by medical doctors / angiologists received clopidogrel (169 versus 11; p < 0.001), significantly more surgical patients received oral anticoagulants (11 versus 7; p = 0.016). The number of patients without prescriptions for any antithrombotic therapy was 6 (6.9 %) in patients treated by vascular surgeons and 0 (0 %) in patients managed by medical doctors / angiologists (p = 0.001). Prescription-rates of beta-blockers, ACE-inhibitors, Angiotensin II-antangonists, calcium channel blockers, and diuretics were statistically not different between the two disciplines, but statins were prescribed significantly more often by medical doctors / angiologists (139 versus 49; p < 0001). With the exceptions of Clopidogrel (women > men) and diuretics (men > women) we observed no gender-specific prescriptions.


CONCLUSIONS
We observed high prescriptions rates of secondary medical prevention in patients primarily treated by medical doctors / angiologists and vascular surgeons. We believe that this result is highly influenced by our multidisciplinary approach. Nevertheless, efforts have to be made to raise vascular surgeons awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.
Klein-Weigel
P F
PF
DRK Kliniken Berlin, Berlin, Germany. p.klein-weigel@web.de
Gutsche-Petrak
B
B
Wolbergs
S
S
Köning
C
C
Flessenkamper
I
I
D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003299:Cooperative Behavior; D019091:Critical Pathways; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D005260:Female; D005263:Femoral Artery; D005858:Germany; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D011150:Popliteal Artery; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D002317:Cardiovascular Agents