Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 • • • • • • • • • • • • 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 • • • • • • • • • • • • 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