Underuse of Prevention and Lifestyle Counseling in Patients With Peripheral Artery Disease
Underuse of Prevention and Lifestyle Counseling in Patients With Peripheral Artery Disease
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DOI：
10.1016/j.jacc.2017.02.064
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发表时间：
2017-05-09
影响因子：
24
通讯作者：
Ladapo, Joseph A.
中科院分区：
文献类型：
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作者：
Berger, Jeffrey S.;Ladapo, Joseph A.
背景对美国外周动脉疾病（PAD）患者的药物使用和生活方式咨询的模式知之甚少。结论作者试图评估2005年至2012年美国PAD患者的药物治疗和生活方式咨询的趋势。982例PAD患者的门诊访视来自国家门诊医疗调查和国家医院门诊医疗调查，这是对办公室和医院门诊部实践的全国代表性评估。药物使用（抗血小板治疗，他汀类药物，血管紧张素转换酶抑制剂[ACEI]或血管紧张素受体阻滞剂[ARB]，西洛他唑）和生活方式咨询（运动或饮食咨询和戒烟）的比例进行了评估的趋势。结果在8年的时间内，在美国的PAD门诊平均每年的数量为3，883，665。在所有访视中，平均年龄为69.2岁，51.8%为女性，56.6%为非西班牙裔白色人。24.3%的访视中存在共病冠状动脉疾病（CAD）。用于心血管预防和跛行症状的药物使用率较低：35.7%（标准误[SE]：2.7%）接受任何抗血小板治疗，33.1%（SE：2.4%）接受他汀类药物，28.4%（SE：2.0%）接受ACEI/ARB，4.7%（SE：1.0%）接受西洛他唑。在22%（SE：2.3%）的访问中使用了运动或饮食咨询。在目前患有PAD的吸烟者中，35.8%（SE：4.6%）的访视使用了戒烟咨询或药物治疗。随着时间的推移，药物使用或生活方式咨询没有显着变化。与单纯PAD患者相比，PAD和CAD共病患者更有可能接受抗血小板治疗（比值比[OR]：2.6; 95%置信区间[CI]：1.8 - 3.9），他汀类药物（OR：2.6; 95% CI：1.8 - 3.9），ACEI/ARB（OR：2.6; 95% CI：1.8 - 3.9），以及戒烟咨询结论：PAD患者使用指南推荐的治疗远低于预期，这突出了提高这些高危患者护理质量的机会。(C)2017年由美国心脏病学会基金会。
BACKGROUND Little is known about patterns of medication use and lifestyle counseling in patients with peripheral artery disease (PAD) in the United States.OBJECTIVES The authors sought to evaluate trends in both medical therapy and lifestyle counseling for PAD patients 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 and National Hospital Ambulatory Medical Care Survey, a nationally representative assessment of office-based and hospital outpatient department practice. Trends in the proportion of visits with medication use (antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and cilostazol) and lifestyle counseling (exercise or diet counseling and smoking cessation) were evaluated.RESULTS Over the 8-year period, the average annual number of ambulatory visits in the United States 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 in 33.1% (SE: 2.4%), ACEI/ARB in 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 with visits for patients with PAD alone, comorbid PAD and CAD were more likely to be prescribed antiplatelet therapy (odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.8 to 3.9), statins (OR: 2.6; 95% CI: 1.8 to 3.9), ACEI/ARB (OR: 2.6; 95% CI: 1.8 to 3.9), and smoking cessation counseling (OR: 4.4; 95% CI: 2.0 to 9.6).CONCLUSIONS The use of guideline-recommended therapies in patients with PAD was much lower than expected, which highlights an opportunity to improve the quality of care in these high-risk patients. (C) 2017 by the American College of Cardiology Foundation.