Affiliation:
1. Saint Luke's Mid America Heart Institute Kansas City MO
2. University of Missouri–Kansas City Kansas City MO
3. Yale University New Haven CT
4. Elisabeth Hospital Tilburg The Netherlands
5. Queen Elisabeth Hospital Adelaide Australia
6. University Hospitals Cleveland OH
7. Duke Clinical Research Institute Durham NC
Abstract
Background
Underuse of guideline‐recommended therapy in peripheral artery disease (
PAD
) in administrative and procedural databases has been described, but reports on medically managed patients and referral to supervised exercise therapy (
SET
) in
PAD
are lacking. We aimed to document the use of
PAD
guideline‐recommended therapy, including
SET
in patients with
PAD
symptoms consulting a specialty clinic across 3 countries.
Methods and Results
The 16‐center PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry enrolled 1275 patients with new or an exacerbation of
PAD
symptoms (2011–2015). We prospectively documented antiplatelet medications, statins, smoking cessation counseling and/or therapy, and referral to
SET
: “2 quality measures” referred to the use of both statin and antiplatelet medications; “4 quality measures” to receiving all 4 measures. Median odds ratios were calculated to quantify treatment variation across sites. A total of 89% patients were on antiplatelets, 83% on statins, and 23% had been referred to
SET
. Of 455 current smokers, 342 (72%) patients received smoking cessation therapy/counseling. Overall, 77.2% of patients received “2 quality measures” and 19.7% “4 quality measures.” The median odds ratio for 2 quality measures was 2.13 (95%
CI
, 1.61–3.56;
P
<0.001) and for 4 quality measures was 5.43 (95%
CI
, 2.84–17.91;
P
<0.001). Variability in adherence was not explained by country, except for referral to
SET
. The odds for
SET
referral in The Netherlands (70% referral rate) was nearly 100 times greater than in
US
sites (2% referral rate).
Conclusions
Not all patients who have undergone a
PAD
workup at a specialty care facility are treated with evidence‐based care, especially so for
SET
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
40 articles.
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