Download A Multicentre Audit of Best Medical Therapy for Aneurysm

Audit of Best Medical Therapy
for Referrals to Vascular Clinic
P Stather, F Muscara,
On behalf of the
VERN Collaborators*
*C Nesbitt, D McCretton, J Shalhoub, A Copland, A Busuttil, R Bootun, S Onida,
A Skinner, N Dattani, L Omotolani, R Edmonds, Z Koshnow, A Tsui, M O’Connell,
A Duncan, J Blackwell, F Muscara, P Stather, Rozelle Kane, P Brooke, D Sidloff, A
Saratzis, D Bosanquet, R Benson, J Pancholi
Background
Increased Cardiovascular Risk
Worse than a history of MI
Aim
Guidelines
• To determine adherence to cardiovascular risk
reduction
guidelines
Antiplatelet
Agent in arterial referrals to
vascular
clinic
Statin Therapy
(Atorvastatin
80mg)
Smoking Cessation
Blood Pressure Control
Lifestyle Modification
Methods
Results
• Data collected
•• Multicentre
audit
656 patients
– Age
–
through
– Promoted
Median age
70.9 years
VERN
– Medications
BMT
Percentage
component
– Cardiovascular risk
• Reason for Referral
Current
Smoker 27.4%
factors
• Retrospective review Aneurysm
– Smoking status
– Patients attending Peripheral
Antiplatelet
59.2%
Arterial Disease
vascular clinic
Statin
61.5%
Carotid/Other
– Aneurysm, Carotid,
Tested for
31.9%
Diabetes
Peripheral Arterial
BP Check
61.3%
Disease
Both Antiplatelet and Statin
47.3%
Antiplatelet, Statin, Not Smoker
34.3%
Results
BMT Component
AAA
PAD
P Value
Current Smoker
27.5%
41.4%
0.01
Antiplatelet
57.8%
60.5%
NS
Statin
56.3%
58.8%
NS
Tested for Diabetes
3.8%
14.3%
<0.001
BP Check
20.8%
39.4%
<0.01
BMT
Hypertension
Diabetes
BMT ComponentStroke/TIA
0 Risk FactorsCardiac1 Hx
Risk Factor
2 Risk Factors
Component
N=65
N=173N=217 N=293 N=143 N=167
N=233
Current Smoker
35.6%
Current
26.2%
Smoker
Antiplatelet
46.8%
Antiplatelet
72.3%
Statin
37.8%
20.8%
23.0%
24.9%
57.6%
23.6%
19.2
77.8%
84.4% 66.4%
67.6%
Statin
Both Meds
Both
All 3 Meds
67.7%
29.2%
53.8%
17.6%
76.3% 47.0%
70.0%
72.3% 35.5%
55.6%
All 3
40.0%
54.3%
42.0%
70.1% 77.2%
63.2% 76.0%
46.5% 65.9%
53.3%
Other
Risk
3/4No
Risk
Factors
Factors
N=63
N=233
20.6%
35.6%
88.9%
46.8%
84.1%
37.8%
77.8%
29.2%
63.5%
17.6%
Conclusions
• Less than half of patients referred to vascular clinic are
on best medical therapy
• Significant numbers have not had diabetic or BP checks
• Smoking cessation advice is still necessary
• The more cardiac risk factors present the better we get
at initiating best medical therapy
• Recommendations
– National drive to highlight vascular disease as a significant
cardiac risk factor
– Referral protocols reminding General Practitioners to start
BMT, check DM and BP and offer smoking cessation
Many thanks to our Collaborators
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Craig Nesbitt
David
Wrexham Maelor Hospital
McCretton
Joe Shalhoub
Alex Coupland
Andrew
Busuttil
Roshan
Royal Gwent
Bootun
Hospital
Sarah Onida
Alex Skinner
Lewis
Omotolani
Nikesh Dattani
Ruth Edmonds
Znar Koshnow
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Adrian Tsui
Megan
O’Connell
Andrew
Duncan
James
Blackwell
Francesca
Muscara
Rozelle Kane
Philip Stather
Peter Brooke
David Sidloff
Athanasios
Saratzis
Dave
Bosanquet
Ruth Benson