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Published on: December 11, 2013
Management of secondary risk factors in patients with intermittent claudication
1Vascular Unit, Ward 36, Aberdeen Royal Infirmary, University of Aberdeen, UK.
Insights
Management of intermittent claudication risk factors is suboptimal. General Practitioners (GPs) attitudes do not always align with patient care regarding smoking cessation, exercise, and antiplatelet therapy for intermittent claudication.
Area of Science:
- Vascular Medicine
- Primary Care Medicine
- Cardiovascular Risk Management
Background:
- Intermittent claudication management emphasizes "best medical therapy," including smoking cessation, exercise, antiplatelet therapy, and risk factor modification.
- Current primary care practices for managing these risk factors in patients with intermittent claudication require assessment.
Purpose of the Study:
- To evaluate the current management of risk factors in patients with intermittent claudication within primary care settings.
- To compare General Practitioner (GP) attitudes towards risk factor management with their actual clinical practices.
Main Methods:
- A postal questionnaire was distributed to 336 GPs in Grampian, Scotland.
- Clinical data, including serum cholesterol, blood glucose, and HbA1c, were collected from 104 new clinic patients referred for claudication.
Main Results:
- A 73% GP response rate was achieved. While 95% of GPs intended to treat risk factors, 28% of patients with intermittent claudication were not on antiplatelet therapy.
- Despite 89% of GPs intending to advise increased exercise, only 14% of patients recalled receiving this advice. Cholesterol management varied, with 14% of GPs not checking levels and 41% treating only levels above 5.5 mmol/l.
- Seventy-seven percent of GPs checked glucose levels, identifying 14% of patients as previously undiagnosed diabetics. Overall, 85% of patients were on statins or had cholesterol above 5 mmol/L.
Conclusions:
- Risk factor management in patients with intermittent claudication is suboptimal in primary care.
- There is a need for specific guidelines for GPs on managing intermittent claudication risk factors.
- Strategies are required to ensure the effective implementation of these guidelines in general practice.
Objectives:
The first line management of patients with intermittent claudication is "best medical therapy" i.e., smoking cessation, exercise, antiplatelet therapy and risk factors modification. The aim of this study was to assess the current management of risk factors in primary care and to compare General Practitioner (GP) attitudes and actual management.
Design And Methods:
Postal questionnaire of all 336 GPs in the referral area (Grampian, Scotland). Questionnaire and measurement of serum cholesterol, blood glucose and HbA1c of new clinic patients (n = 104) with claudication referred by general practitioners.
Results:
A 73% GP response rate was obtained. Ninety-five percent of GPs would treat risk factors. The vast majority would prescribe aspirin, yet 28% of patients were on no anti-platelet therapy. Eighty-nine percent of GPs would advise an increase in exercise but only 14% of patients recalled being told to do so. One in seven of the GPs would not check serum cholesterol, 18% considered cholesterol lowering therapy to be primary prevention and 41% would only treat levels above 5.5 mmol/l. Eighty-five percent of patients were on a statin or had a cholesterol above 5 mmol/L. Seventy-seven percent of GPs would check glucose levels, and 14% of patients were found to be previously undiagnosed diabetics.
Conclusions:
Risk factors in claudicants are suboptimally managed. Urgent guidelines for the specific management of claudicants by general practitioners, as well as strategies to ensure their implementation, are required.
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