Atherosclerotic risk factor reduction in peripheral arterial disease - Results of a national physician survey
Atherosclerotic risk factor reduction in peripheral arterial disease - Results of a national physician survey
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DOI：
10.1046/j.1525-1497.2002.20307.x
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发表时间：
2002-12-01
影响因子：
5.7
通讯作者：
Hudgens, S
中科院分区：
文献类型：
--
作者：
McDermott, MM;Hahn, EA;Hudgens, S
目的：与没有外周动脉疾病（PAD）的人相比，患有PAD的人患冠心病和中风的风险增加3至6倍。我们记录了医生报告的关于PAD患者动脉粥样硬化危险因素减少的实践行为、知识和态度。设计：全国医生调查。患者/参与者：普通内科医生（N = 406）、家庭医生（N = 435）、心脏病专家（N = 473），和血管外科医生（N = 264）随机确定使用美国医学协会的医生数据库。测量和主要结果：医生被随机分配至3份问卷中的1份，描述a）55- 65岁的PAD患者; B）55- 65岁的冠状动脉疾病（CAD）患者;或c）55- 65岁的无临床明显动脉粥样硬化（无疾病）患者。通过邮寄问卷调查，比较医生对每例患者降低风险因素的行为、知识和态度。PAD患者的抗血小板治疗处方率显著低于CAD患者。对于CAD、PAD和无疾病患者，医生“几乎总是”开始使用降脂药物的平均低密度脂蛋白水平分别为121.6 +/- 23.5 mg/dL、136.3 +/- 28.9 mg/dL和149.7 +/- 24.4 mg/dL（P <0.001）。医生指出，抗血小板治疗（P <0.001）和降胆固醇治疗（P <0.001）对CAD患者的重要性显著高于PAD患者。危险因素干预的重要性与实践行为高度相关。与其他专业相比，心脏病专家的阈值最低，而血管外科医生对PAD患者进行降胆固醇干预的阈值最高。心脏病专家更有可能报告“几乎总是”处方抗血小板治疗的患者PAD比所有其他physics.CONCLUSIONS：Defersion在医生的知识和态度有助于降低动脉粥样硬化危险因素减少PAD患者的发病率。逆转这些缺陷可能会降低与PAD相关的高心血管发病率和死亡率。
OBJECTIVE: Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD.DESIGN: National physician survey.PATIENTS/PARTICIPANTS: General internists (N = 406), family practitioners (N = 435), cardiologists (N = 473), and vascular surgeons (N = 264) randomly identified using the American Medical Association's physician database.MEASUREMENTS AND MAIN RESULTS: Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians "almost always" initiated lipid-lowering drugs were 121.6 +/- 23.5 mg/dL, 136.3 +/- 28.9 mg/dL, and 149.7 +/- 24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (P < .001). Physicians stated that antiplatelet therapy (P < .001) and cholesterol-lowering therapy (P < .001) were extremely important significantly more often for the CAD than for the PAD patient. Perceived importance of risk factor interventions was highly correlated with practice behavior. Compared to other specialties, cardiologists had lowest thresholds, whereas vascular surgeons had the highest thresholds for initiating cholesterol-lowering interventions for the patient with PAD. Cardiologists were significantly more likely to report "almost always" prescribing antiplatelet therapy for the patient with PAD than were all other physicians.CONCLUSIONS: Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.