Preventative medical Preventative medical practices in practices in patients with patients with vascular occlusive vascular occlusive disease at Royal disease at Royal Perth Hospital Perth Hospital Lip Gen Teh MBBS Kishore Sieunarine MBBS FRCSE FRACS John Eikelboom MBBS FRACP FRCPA
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Preventative medical practices in patients with vascular occlusive disease at Royal Perth Hospital Lip Gen Teh MBBS Kishore Sieunarine MBBS FRCSE FRACS.
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Preventative medical Preventative medical practices in patients practices in patients with vascular occlusive with vascular occlusive disease at Royal Perth disease at Royal Perth HospitalHospital
– WarfarinWarfarin• ?50% reduction in all cause mortality in ?50% reduction in all cause mortality in
5 years5 years
Study AimStudy Aim
• Investigate the pattern of Investigate the pattern of preventive practices in a high risk preventive practices in a high risk group of patients.group of patients.– 2 groups: (1) PVD (2) carotid disease2 groups: (1) PVD (2) carotid disease
• Examine possible reasons for low Examine possible reasons for low rates of preventive practicesrates of preventive practices
DesignDesign
• Restrospective case note reviewRestrospective case note review
• InclusionInclusion– all first inpatient admissions all first inpatient admissions
undergoing a diagnostic or therapeutic undergoing a diagnostic or therapeutic procedure for vascular occlusive procedure for vascular occlusive disease in the year 2000disease in the year 2000
ResultsResults
• 262 cases identified262 cases identified
• 6 (2.3%) case notes unavailable6 (2.3%) case notes unavailable
DemographicsDemographics
Overall PVD CarotidN 256 189 67
Age (years) mean 70.2 70.2 70.1 median 71.0 71.0 41.0 range 35-98 35-98 86.0 std dev 10.9 11.4 9.1
Sex males 68.4% 66.7% 73.5% females 31.6% 33.3% 26.5%
LOS (days) mean 9.3 10.6 5.7 median 6.0 7.0 4.0 range 1-70 1-70 1-20 std dev 10.0 11.0 4.0
• 6 TIAs and 1 stroke overall6 TIAs and 1 stroke overall– 4 TIAs in carotid endarterectomies (7%)4 TIAs in carotid endarterectomies (7%)
– all in symptomatic patients (10.3%)all in symptomatic patients (10.3%)
Antiplatelet TherapyAntiplatelet Therapy
• Overall, 29.7% not on any form of Overall, 29.7% not on any form of antiplatelet therapyantiplatelet therapy– carotid group 6% not on antiplateletcarotid group 6% not on antiplatelet
– PVD group 38.1% not on antiplateletPVD group 38.1% not on antiplatelet
WarfarinWarfarin
• 16% on warfarin16% on warfarin
• 6% in carotid group6% in carotid group
• 20% in PVD group20% in PVD group
• 19.5% not on antiplatelet or 19.5% not on antiplatelet or antithrombotic therapyantithrombotic therapy
• in PVD patients with no vascular co-in PVD patients with no vascular co-morbidities (n=115)morbidities (n=115)
• 51.4% were on antiplatelet versus 51.4% were on antiplatelet versus 75.6% in those with vascular co-75.6% in those with vascular co-morbiditiesmorbidities
AntihypertensivesAntihypertensives
• 72% on antihypertensives72% on antihypertensives– 83% in carotid patients83% in carotid patients
– 68% in PVD patients68% in PVD patients
– (chi sq=4.7, p=0.03)(chi sq=4.7, p=0.03)
• beta blockersbeta blockers– 34% in carotid34% in carotid
– 18% in PVD18% in PVD
AnticholesterolAnticholesterol
• 43% on cholesterol lowering therapy43% on cholesterol lowering therapy– 63% in carotid63% in carotid
– 36% in PVD36% in PVD
– (chi sq=14.4, p<0.001)(chi sq=14.4, p<0.001)
HypoglycaemicsHypoglycaemics
• 76.9% of diabetics on glucose 76.9% of diabetics on glucose lowering medications overalllowering medications overall– 83% in carotid83% in carotid
– 75% in PVD75% in PVD
DiscussionDiscussion
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Perth Copenhagen Ontario
AntiplateletAntilipid
DiscussionDiscussion
• Rate of preventive practices are 2x Rate of preventive practices are 2x higher for antiplatelet and antilipid higher for antiplatelet and antilipid therapies.therapies.
• Long term prognosis of claudicants Long term prognosis of claudicants is poor and mortality approaches is poor and mortality approaches that of those with carotid disease.that of those with carotid disease.
DiscussionDiscussion
• compared to carotid patients, use of compared to carotid patients, use of preventive therapies are suboptimal in preventive therapies are suboptimal in PVD patients.PVD patients.
• Subgroup most neglected are those Subgroup most neglected are those with no coexistent coronary or with no coexistent coronary or cerebrovascular comorbiditiescerebrovascular comorbidities
– main medical contact are vascular main medical contact are vascular surgeonssurgeons