Abstract 15753: Center Based Care Improves Survival in Patients Suffering From Peripheral Arterial Disease
Introduction: Advances in cardiovascular management have ameliorated mortality rates. However, management of peripheral arterial disease (PAD) remains challenging due to the comorbidities in those mostly elderly patients.
Hypothesis: Possible reduction of mortality in PAD patients by center-based care.
Methods: All patients were examined at baseline at the vascular medicine center (VMC) of the Medical University Vienna. The cohort was longitudinally followed-up for five years in two groups managed by their general practitioner (GP, N=332) or VMC (N=370). VMC patients had visits every six month including physical examination of the feet, non-invasive imaging of arterial perfusion, and blood draws (glucose tolerance test, HbA1c, LDL-cholesterol). Furthermore, reassessment of the current medication schedule and, if indicated, non-invasive tests of cardiac and pulmonary function were performed.
Results: Survival was 66% for GP managed patients and 90.8% for patients managed at VMC within five years. In a multivariate model including the known risk factors for PAD (gender, age, diabetes, smoking, hypertension, hyperlipidemia, c-reactive protein (CRP) and nephropathy) at baseline only nephropathy (HR 2.7 (95% CI: 1.38-5.45)), CRP (HR per 1STD: 1.36 (95% CI: 1.10-1.73) and age (HR per 1 STD 1.46 (95% CI: 1.03-1.86)) were connected to mortality during 5 years of follow up in VMC patients. In the GP group no single predictive risk factor could be identified. Patients in both groups were equally affected by coronary (p=0.076) or carotid artery disease (p=0.555) at baseline. Center based patients showed significantly higher prevalence of hypertension (p<0.001), hyperlipidemia (p<0.001), and nephropathy (p=0.001). Both groups were comparable for the risk factor smoking (p=0.988) and diabetes (p=0.074).
Conclusions: Center based care of patients with PAD including physical examination of the feet and repetitive vascular assessment by non-invasive imaging technics improves mortality. Furthermore, constant screening for diabetes, hyperlipidemia and cardiovascular and pulmonary complications in these high-risk patients can accelerate further medical decision including medication changes.
Author Disclosures: C. Hoebaus: None. M. Tscharre: None. M. Howanietz: None. A. Winkler: None. R. Koppensteiner: None. G. Schernthaner: None.
- © 2015 by American Heart Association, Inc.