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Meeting AHA/ACC secondary prevention goals in a vascular surgery practice: an opportunity we cannot afford to miss
Daniel Kinikini1, Mark R Sarfati, Michelle T Mueller
1Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City 84132-2301, USA.
Insights
Compliance with secondary prevention guidelines for atherosclerotic arterial disease is suboptimal. Patients with prior vascular intervention (EVENT) showed better adherence to risk factor modification goals, highlighting a need for targeted interventions to reduce cardiovascular mortality.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Preventive Cardiology
Background:
- Atherosclerotic arterial disease necessitates risk factor modification per American Heart Association/American College of Cardiology (AHA/ACC) guidelines to reduce cardiovascular mortality.
- Compliance with these secondary prevention guidelines is crucial for patient outcomes.
Purpose of the Study:
- To assess compliance with AHA/ACC Secondary Prevention Guidelines in patients with atherosclerotic arterial disease treated in a vascular surgery practice.
- To compare compliance rates between established and new patients, and between those with and without prior vascular interventions.
Main Methods:
- Evaluation of 200 consecutive patients with lower-extremity occlusive disease, cerebrovascular disease, or abdominal aortic aneurysm.
- Data collection on nine AHA/ACC Guideline goals via patient interviews, medication histories, and laboratory records.
- Comparison of compliance between established vs. new patients and between patients with prior vascular intervention (EVENT) vs. no prior intervention (NO EVENT).
Main Results:
- Overall suboptimal compliance with secondary prevention goals was observed.
- Patients with a prior vascular intervention (EVENT) demonstrated significantly higher achievement rates for low-density lipoprotein levels and use of statins, beta-blockers, ACE inhibitors, and antiplatelet agents.
- Established patients were more likely to have had a prior EVENT and achieved more guideline goals, likely due to the higher proportion of EVENT patients.
Conclusions:
- Compliance with secondary prevention guidelines in atherosclerotic arterial disease patients is suboptimal.
- Prior vascular intervention (EVENT) is associated with improved adherence to risk factor modification, potentially due to increased awareness.
- Targeted efforts for risk factor modification are needed to improve guideline compliance and reduce cardiovascular mortality in this patient population.
Objective:
In an effort to reduce cardiovascular mortality, patients with atherosclerotic arterial disease should undergo risk factor modification according to the American Heart Association/American College of Cardiology (AHA/ACC) Secondary Prevention Guidelines (hereafter, Guideline). We assessed compliance with the Guideline in a group of patients seen in a vascular surgery practice.
Methods:
We evaluated 200 consecutive patients with lower-extremity occlusive disease, cerebrovascular disease, or abdominal aortic aneurysm seen by a university-based vascular surgery practice. The subjects were patients who had been seen previously in our clinic (ESTABLISHED) and new referrals (NEW). Data pertinent to each of the nine AHA/ACC Guideline goals were collected from patient interviews, medication histories, and laboratory records. Compliance with each of the Guideline goals was evaluated. Differences in compliance between ESTABLISHED and NEW patient groups were also compared. We also recorded whether a patient had a previous endovascular or open surgical vascular intervention (EVENT or NO EVENT). Differences in compliance between the EVENT and NO EVENT groups were compared.
Results:
Most patients did not achieve the secondary prevention goals recommended in the Guideline. Patients who had a prior vascular intervention (EVENT) were significantly more likely to achieve goals for low-density lipoprotein level (43% vs 23%), and for statin (71% vs 39%), beta-blocker (46% vs 27%), angiotensin-converting enzyme inhibitor (53% vs. 35%), and antiplatelet agent (85% vs. 68%) use (P < .05). ESTABLISHED patients were significantly more likely than NEW patients to have a prior EVENT (87% vs 47%, P < .0005). ESTABLISHED patients were significantly more likely than NEW patients to achieve goals for low-density lipoprotein level, beta-blocker, and statin use; however, these differences were likely due to the higher proportion of EVENT patients in the ESTABLISHED group.
Conclusion:
Compliance with the Guideline is suboptimal in patients with atherosclerotic arterial disease. Secondary prevention goals were more often achieved in the EVENT patient group, suggesting that a vascular intervention may lead to increased patient and physician awareness and compliance with the Guideline. A targeted effort towards risk factor modification in patients with atherosclerotic arterial disease could improve compliance with the Guideline and reduce cardiovascular mortality.
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