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Risk-reduction program improves outcomes for patients with symptomatic PAD
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Patients with peripheral artery disease who participated in an education program focused on guideline-recommended reduction of risk factors experienced lower rates of mortality and CV and limb events over 7 years.
In an observational cohort study, researchers evaluated data on 290 patients with symptomatic PAD from July 2004 to April 2013. All patients were enrolled in the Systematic Assessment of Vascular Risk (SAVR) program at a single center in Ontario, Canada.
The program was designed to educate patients about PAD, relevant risk factors and management techniques. The program also promoted use of antiplatelet medications, statins and ACE inhibitors, as well as BP, lipid and glycemic control, smoking cessation and achieving a target BMI. Patients underwent regular follow-up risk assessments, along with a formal follow-up visit before completion of the program in November 2014. Mean follow-up was 5.3 years.
The researchers matched all patients with up to two propensity-matched controls with PAD who were treated at other centers in and were not enrolled in the program, for a total of 791 evaluated patients.
The primary outcome was a composite of risk for death, acute MI and ischemic stroke. Lower-limb amputation, surgical bypass and peripheral angioplasty rates were secondary outcomes.
The primary outcome occurred in 43% of patients enrolled in the program compared with 58% of controls (adjusted HR = 0.63; 95% CI, 0.52-0.77). Specifically, death occurred significantly less frequently among patients (adjusted HR = 0.6; 95% CI, 0.48-0.75), whereas acute MI and ischemic stroke occurred at similar rates between the groups.
Patients enrolled in the program exhibited lower rates of major amputation (adjusted HR = 0.47; 95% CI, 0.29-0.77), minor amputation (adjusted HR = 0.26; 95% CI, 0.13-0.54), bypass (adjusted HR = 0.47; 95% CI, 0.3-0.73) and HF-related hospitalization (adjusted HR = 0.73; 95% CI, 0.53-1). However, the researchers wrote, patients in the SAVR group were at increased risk of peripheral angioplasty compared with controls (adjusted HR = 2.97; 95% CI, 2.15-4.1).
Among 99 patients with evaluable follow-up data at the end of the program (mean 8.4 years), improvements from baseline occurred with regard to adherence to antiplatelet therapy (80% vs. 67%; P = .03), statins (88% vs. 67%; P < .001), ACE inhibitors or angiotensin receptor blockers (72% vs. 58%; P = .02), BP control (52% vs. 35%; P = .02), LDL control (86% vs. 63%; P = .002), smoking cessation (88% vs. 75%; P < .001) and target BMI (38% vs. 27%; P = .049).
“Patients with PAD who receive an educational intervention focused on all eight major guideline-recommended risk reduction therapies experience lower rates of CV and limb events over 7 years,” the researchers concluded. “Greater focus is needed on developing structured programs for improving controls over risk factors for patients with PAD, as this may reduce CV morbidity and mortality over the long term.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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