Secondary medical prevention after primary vascular surgery between 1996 and 2006: a shift towards more evidence-based treatment.
OBJECTIVE
The implementation of evidence-based secondary medical prevention in peripheral arterial disease (PAD) patients has received increasing attention in recent years, but population-based data are sparse. This study examined the use of secondary medical prophylaxis in unselected symptomatic PAD patients in Denmark.


METHODS
A nationwide follow-up study based on individual-level record linkages of population-based healthcare registers was performed.


METHODS
All patients who underwent primary vascular reconstruction in Denmark between 1996 and 2006 with a minimum of 6 months of follow-up were included (n = 16,492).


METHODS
Data were obtained from prescriptions that were filled six months after primary vascular reconstruction (±90 days). The use of secondary medical prevention was examined according to calendar year and place of residence.


RESULTS
The use of lipid-lowering drugs increased from 32.2% in 1996 to 76.1% in 2006 (adjusted relative risk (RR) 1.95, 95% CI 1.81-2.10). The overall use of antihypertensive therapy was unchanged during the study period, but treatment shifted from diuretics/calcium antagonists towards angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The use of combination therapy (concomitant lipid-lowering, antiplatelet and any antihypertensive therapies) increased from 29.1% in 1996 to 67.6% in 2006 (adjusted RR 1.95, 95% CI 1.80-2.12). This shift in the use of secondary medical prevention was independent of sociodemographic and clinical factors. No substantial differences in pharmacological use based on place of residence were observed.


CONCLUSIONS
The use of evidence-based secondary medical prevention, especially lipid-lowering drugs, increased substantially among symptomatic PAD patients in Denmark from 1996 to 2006. However, recommendations in current clinical guidelines suggest that room for improvement remains.
Department of Vascular Surgery, Regionshospitalet Viborg, Denmark.
Annette
A
Høgh
Jes S
JS
Lindholt
Henrik
H
Nielsen
Leif P
LP
Jensen
Søren P
SP
Johnsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003718:Denmark; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review / Q000639:trends; D019317:Evidence-Based Medicine / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000639:trends; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D012042:Registries; D055502:Secondary Prevention / Q000379:methods / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors