Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Comparative Study of the Results of a Three-year Observation of Cardiologists and Surgeons in Patients with Peripheral Atherosclerosis

https://doi.org/10.20996/1819-6446-2019-15-5-690-696

Full Text:

Abstract

Aim. To compare the results of 3-year follow-up of patients with peripheral atherosclerosis (PA) in two patient cohorts: during outpatient monitoring by cardiologists and when observed by surgeons.

Material and methods. The first group included 131 patients with PA who sought medical attention in outpatient clinic in 2013-2014 and then were observed by a surgeon. The second group is represented by 454 patients with PA who sought medical attention in outpatient clinic in 2010- 2012 and then underwent observation by a cardiologist as a part of a pilot project. The average follow-up duration in the studied groups was three years. The groups were compared according to the main demographic, anthropometric indicators, the presence of risk factors for atherosclerosis, comorbidity, the prevalence of atherothrombotic events in history, laboratory and instrumental examination data. Additionally, after 3 years of observation the incidence of deaths and amputations was assessed in groups.

Results. Patients of the second group were older than these in the first group (p<0.001). Patients of the group 1 compared to the group 2 were more often overweight (p=0.005), suffered from diabetes mellitus (p<0.001), had a disability (p<0.001). Among patients of the group 2 compared with the group 1, the clinical picture of angina pectoris (p=0.001), rhythm disorders (p=0.058) were more often observed, they had a greater number of myocardial infarctions (p<0.001) and myocardial revascularization operations in the history: coronary bypass surgery (p=0.029), percutaneous coronary interventions (p<0.001), and underwent coronary angiography (p<0.001). Patients in group 2 were more likely to receive statins (p<0.001), β-blockers (p<0.001), angiotensin-converting enzyme inhibitors, and calcium channel blockers, angiotensin II receptor blockers, and antiarrhythmics (p<0.001). Pentoxifylline was prescribed more often in the first group (p<0.001). With a three-year observation of PA patients a fatal outcome occurred in 8.2% of cases, amputation – in 1.4%. In the first group, compared with the second one, there were more often observed deaths in general (p=0.023), death from cardiac causes, stroke, disability (p=0.005) and amputations (p=0.003). The risk of adverse outcomes (death and amputations) was increased in the presence of signs of chronic lower limb ischemia of stage III, a history of amputation, more than 70% stenosis and occlusions of lower limb arteries, chronic lung disease, and angina symptoms. The risk of adverse outcomes was decreased in outpatient observation by cardiologist, taking statins, aspirin, and performing exercise therapy.

Conclusion. Observation of PA patients by a cardiologist results in more frequent optimal drug therapy (due to the better adherence of cardiologists to clinical recommendations for the treatment of such patients) and improves the prognosis of these patients. 

About the Authors

L. S. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

MD, PhD, Professor, Academician of the Russian Academy of Sciences, Chief Researcher,

Sosnoviy bulv. 6, Kemerovo, 650002



A. N. Sumin
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

MD, PhD, Head of Department of Multifocal Atherosclerosis,

Sosnoviy bulv. 6, Kemerovo, 650002



Yu. D. Medvedeva
Kemerovo Regional Cardiology Dispensary
Russian Federation

MD, Cardiovascular Surgeon,

Sosnoviy bulv. 6, Kemerovo, 650002 



E. V. Korok
Research Institute for Complex Issues of Cardiovascular Diseases
Russian Federation

MD, PhD, Researcher, Laboratory of Circulatory Pathology, Department of Multifocal Atherosclerosis, 

Sosnoviy bulv. 6, Kemerovo, 650002



References

1. Hussain M.A., Al-Omran M., Mamdani M., et al. Efficacy of a Guideline-Recommended Risk-Reduction Program to Improve Cardiovascular and Limb Outcomes in Patients With Peripheral Arterial Disease. JAMA Surg. 2016;151(8):742-50. DOI:10.1001/jamasurg.2016.0415.

2. Blinc A., Kozak M., Šabovič M., et al. Survival and event-free survival of patients with peripheral arterial disease undergoing prevention of cardiovascular disease. Int Angiol. 2017;36(3):216-27. DOI:10.23736/S0392-9590.16.03731-7.

3. O'Donnell T.F.X., Deery S.E., Darling J.D., et al. Adherence to lipid management guidelines is associated with lower mortality and major adverse limb events in patients undergoing revascularization for chronic limb-threatening ischemia. J Vasc Surg. 2017;66(2):572-8. DOI:10.1016/j.jvs.2017.03.416.

4. Thiney M., Della Schiava N., Ecochard R., et al. Effects on Mortality and Cardiovascular Events of Adherence to Guideline-Recommended Therapy 4 Years after Lower Extremity Arterial Revascularization. Ann Vasc Surg. 2018;52:138-46. DOI:10.1016/j.avsg.2018.03.021.DOI:10.1161/JAHA. 117.005699.

5. Foley T.R., Singh G.D., Kokkinidis D.G., et al. High-Intensity Statin Therapy Is Associated With Improved Survival in Patients With Peripheral Artery Disease. J Am Heart Assoc. 2017;6(7):e005699. DOI:10. 1161/JAHA.117.005699.

6. Armstrong E.J., Chen D.C., Westin G.G., et al. Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease. J Am Heart Assoc. 2014;3(2):e000697. DOI:10.1161/JAHA.113.000697.

7. Chen D.C., Armstrong E.J., Singh G.D., et al. Adherence to guideline-recommended therapies among patients with diverse manifestations of vascular disease. Vasc Health Risk Manag. 2015;11:185-92. DOI:10.2147/VHRM.S76651.

8. Poredos P., Jezovnik M.K. Do the Effects of Secondary Prevention of Cardiovascular Events in PAD Patients Differ from Other Atherosclerotic Disease? Int J Mol Sci. 2015;16(7):14477-89. DOI:10.3390/ijms160714477.

9. Berger J.S., Ladapo J.A. Underuse of Prevention and Lifestyle Counseling in Patients With Peripheral Artery Disease. J Am Coll Cardiol. 2017;69(18):2293-300. DOI:10.1016/j.jacc.2017.02.064.

10. McBride C.L., Akeroyd J.M., Ramsey D.J., et al. Statin prescription rates and their facility-level variation in patients with peripheral artery disease and ischemic cerebrovascular disease: Insights from the Department of Veterans Affairs. Vasc Med. 2018;23(3):232-40. DOI:10.1177/1358863X18758914.

11. Renard B.M., Seth M., Share D., et al. If not now, when? Prescription of evidence-based medical therapy prior to hospital discharge increases utilization at 6 months in patients with symptomatic peripheral artery disease. Vasc Med. 2015;20(6):544-50. DOI:10.1177/1358863X15599249.

12. Montminy M.L., Gauvin V., Turcotte S., et al. Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease. PLoS One. 2016;11(2):e0148069. DOI:10.1371/journal.pone.0148069.

13. Sigvant B., Kragsterman B., Falkenberg M., et al. Contemporary cardiovascular risk and secondary preventive drug treatment patterns in peripheral artery disease patients undergoing revascularization. J Vasc Surg. 2016;64(4):1009-17.e3. DOI:10.1016/j.jvs.2016.03.429.

14. Thiney M., Della Schiava N., Feugier P., et al. How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease. Ann Vasc Surg. 2017;40:85-93. DOI:10.1016/j.avsg.2016.08.030.

15. Meltzer A.J., Sedrakyan A., Connolly P.H., et al.; Vascular Study Group of Greater. Risk Factors for Suboptimal Utilization of Statins and Antiplatelet Therapy in Patients Undergoing Revascularization for Symptomatic Peripheral Arterial Disease. Ann Vasc Surg. 2018;46:234-40. DOI:10.1016/j.avsg.2017.05.030.

16. Kumbhani D.J., Steg P.G., Cannon C.P., et al.; REACH Registry Investigators. Statin therapy and longterm adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry. Eur Heart J. 2014;35(41):2864-72. DOI:10.1093/eurheartj/ehu080.

17. Arya S., Khakharia A., Binney Z.O., et al. Association of Statin Dose with Amputation and Survival in Patients With Peripheral Artery Disease. Circulation. 2018;137(14):1435-46. DOI:10.1161/CIRCULATIONAHA.117.032361.

18. Bodewes T.C.F., Darling J.D., O'Donnell T.F.X., et al. Long-term mortality benefit of renin-angiotensin system inhibitors in patients with chronic limb-threatening ischemia undergoing vascular intervention. J Vasc Surg. 2018;67(3):800-8.e1. DOI:10.1016/j.jvs.2017.07.130.

19. Aboyans V., Ricco J.B., Bartelink M.E.L., et al. ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. Eur Heart J. 2018;39(9):763-816. DOI:10.1093/eurheartj/ehx095.

20. Cea-Soriano L., Fowkes F.G.R., Johansson S., et al. Time trends in peripheral artery disease incidence, prevalence and secondary preventive therapy: a cohort study in The Health Improvement Network in the UK. BMJ Open. 2018;8(1):e018184. DOI:10.1136/bmjopen-2017-018184.

21. Lane R., Harwood A., Watson L., Leng G.C. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2017 Dec 26;12:CD000990. DOI:10.1002/14651858.CD000990.pub4.

22. Devrome A.N., Aggarwal S., McMurtry M.S., et al. Cardiac rehabilitation in people with peripheral arterial disease: A higher risk population that benefits from completion. Int J Cardiol. 2019;285:108- 14. DOI:10.1002/14651858.CD000990.pub4.

23. Hageman D., Fokkenrood H.J., Gommans L.N., et al. Supervised exercise therapy versus home-based exercise therapy versus walking advice for intermittent claudication. Cochrane Database Syst Rev. 2018;4:CD005263. DOI:10.1002/14651858.CD005263.pub4.

24. McDermott M.M., Spring B., Berger J.S., et al. Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial. JAMA. 2018;319(16):1665-76. DOI:10.1001/jama.2018.3275.

25. Sumin A.N., Kosova M.A., Medvedeva J.D., et al. Factors Influencing on the Mortality in Patients with Obliterating Diseases of Lower Limb Arteries. Rational Pharmacotherapy in Cardiology 2017;13(6):746-55. DOI:10.20996/1819-6446-2017-13-6-746-755 (In Russ).


For citation:


Barbarash L.S., Sumin A.N., Medvedeva Y.D., Korok E.V. Comparative Study of the Results of a Three-year Observation of Cardiologists and Surgeons in Patients with Peripheral Atherosclerosis. Rational Pharmacotherapy in Cardiology. 2019;15(5):690-696. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-5-690-696

Views: 26


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)