title: Effect of guideline orientation on the outcomes of peripheral arterial disease in primary care.
abstract: OBJECTIVE
  Peripheral arterial disease (PAD), an established marker of premature death and cardiovascular risk in general, is highly prevalent. We analysed factors associated with poor outcomes in an observational cohort, with particular focus on the effect of guideline orientation in the management of these patients.
  
  
  METHODS
  PACE-PAD is a multicentre, prospective, observational study of PAD patients in primary care. PAD guideline orientation was stated, if patients received the following: exercise training, (if applicable) advice for smoking cessation and diet, therapy for diabetes mellitus, hypertension, hypercholesterolaemia, or antiplatelets/anticoagulants. Multivariate regression models were applied to assess factors associated with all cause death, cardiovascular/cerebrovascular death, or cardiovascular/cerebrovascular/peripheral vascular non-fatal events.
  
  
  RESULTS
  After an 18-month follow-up, of the 5099 PAD patients analysed (mean age 68.0 ± 9.0 years, 68.5% males), only 28.4% of patients met all applicable quality indicators for guideline-oriented treatment. However, most patients were to a large extent managed in line with guidelines. While exercise training was reported in 41.8%, rates were very high for smoking cessation (90.7%), therapy for hypertension (92.5%), diabetes mellitus (82.0%), hypercholesterolemia (83.3%) and antiplatelet therapy (86.7%). Regarding events, there were inhomogeneous results with a statistically significant higher rate of cardiovascular/cerebrovascular deaths and all-cause deaths, but a lower rate of non-fatal vascular events in patients treated according to guidelines compared to those who were not. Limitations of this study include the open, non-controlled design, possible patient selection bias and misclassification of events.
  
  
  CONCLUSIONS
  Even if the guideline orientation for the various indicators was remarkably stable across the three follow-up visits, the rate of patients comprehensively treated according to the guidelines was relatively low, which calls for optimisation. There was a lack of differentiation between the guideline-oriented and non-guideline-oriented therapy in terms of outcomes, which may be due to patient-related or other factors, and warrants further research.
authors.affiliation: Institute for Health Care Management and Research, University Duisburg-Essen, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jahn
authors.forename: Curt
authors.initials: C
authors.lastname: Diehm
authors.forename: Gerald
authors.initials: G
authors.lastname: Lux
authors.forename: Elke
authors.initials: E
authors.lastname: Driller
authors.forename: Franz
authors.initials: F
authors.lastname: Hessel
authors.forename: Oliver
authors.initials: O
authors.lastname: Ommen
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.forename: Anja
authors.initials: A
authors.lastname: Neumann
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000178:diet therapy / Q000188:drug therapy / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012044:Regression Analysis; D016896:Treatment Outcome