Abstract 17323: Adherence to ACC/AHA Treatment Guidelines for PAD Across Treatment Sites: Insight From the PORTRAIT Registry
Introduction: No prospective studies have reported the adherence to ACC/AHA peripheral arterial disease (PAD) performance measures. We examined the quality of care for patients with intermittent claudication across PAD specialty care centers using the ACC/AHA performance measures.
Methods: We enrolled 1276 patients with new or an exacerbation of intermittent claudication presenting for vascular subspecialty care in the 16-center PORTRAIT registry. The adherence rate to 4 PAD performance measures - antiplatelet medications, statins, referral for tobacco cessation (TC), and referral to supervised exercise therapy (ET) - was assessed at the time the initial evaluation. We compared the likelihood of (1) use of both statin and antiplatelet medications (‘perfect medical care’) and (2) use of perfect medical care plus referral for relevant therapies (‘perfect medical care + therapy referral’). Referral for therapies was defined as ET for non-smokers and ET+TC for smokers. We calculated median odds ratios (MOR) to quantify treatment variation across sites.
Results: Of 1276 patients (62% male), 1105 (89%) were prescribed antiplatelets, 1056 (83%) were prescribed statins, and 280 (23%) had been referred to ET. Of 474 current smokers, 342 (72%) had been referred to TC. There was a high degree of variability in achieving ‘perfect medical care’ and ‘perfect medical care + therapy referral’ across sites (Figure 1). The MOR for achieving perfect medical care was 2.13 (p<0.001) and for perfect medical care + referrals was 5.49 (p <0.001).
Conclusions: At the time of referral for PAD specialty care, prescription rates for antiplatelet therapy, statins, and referral for TC were relatively high; referral to ET was notably low. Marked variability by treatment sites was observed for the attainment of perfect care, indicating an important opportunity for improving the care of patients with PAD.
Author Disclosures: J.T. Saxon: None. K. Smolderen: None. J. Spertus: None. K. Gosch: None. M.R. Patel: None. A. Hirsch: None. D.M. Safley: None.
- © 2016 by American Heart Association, Inc.