Abstract 16935: Underuse of Cardiovascular Prevention and Lifestyle Counseling in Peripheral Artery Disease
Introduction: Previous studies suggest that cardiovascular prevention medications are underutilized in the setting of peripheral artery disease. Using nationally representative data, we sought to evaluate trends in the medical therapy and lifestyle counseling of PAD in the United States from 2005 through 2012.
Methods: Data from 1,982 outpatient visits among patients with PAD were obtained from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative assessment of office-based and hospital outpatient department practice. We assessed trends in medication use (antiplatelet therapy [aspirin and/or clopidogrel], statins, cilostazol, and ACE-Inhibitors [ACE-I] or Angiotensin receptor blockers [ARB]) and lifestyle counseling (exercise or diet counseling and smoking cessation).
Results: Over the 8-year period, the average annual number of ambulatory visits in the U.S. for PAD was 3,883,665. Across all visits, mean age was 69.2 years, 51.8% were female and 56.6% were Non-Hispanic white. Comorbid coronary artery disease (CAD) was present in 24.3% of visits. Medication use for cardiovascular prevention and symptoms of claudication was low: any antiplatelet therapy in 35.7% (standard error [SE] 2.7), statin 33.1% (SE, 2.4), ACE-I/ARB 28.4% (SE, 2.0), and cilostazol in 4.7% (SE, 1.0) of visits. Exercise or diet counseling was used in 22% (SE, 2.3) of visits. Among current smokers with PAD, smoking cessation counseling or medication was used in 35.8% (SE, 4.6) of visits. There was no significant change in medication use or lifestyle counseling over time. Compared to visits for patients with PAD alone, comorbid PAD and CAD were more likely to be prescribed antiplatelet therapy (OR 2.6 [1.8-3.9]), statins (OR 2.6 [1.8-3.9]), ACE-I/ARB (OR 2.6 [1.8-3.9]), and counseled for smoking cessation (OR 4.4 [2.0-9.6]).
Conclusions: The use of guideline recommended therapies in patients with PAD was much lower than expected. These data highlight a clear opportunity to improve the quality of care in this high-risk group of patients.
Author Disclosures: J.S. Berger: None. J.A. Ladapo: None.
- © 2016 by American Heart Association, Inc.