Key result
Vascular surgery admission led to improved prescribing rates by discharge for antiplatelets (82.3% to 94.6%) and lipid-lowering therapy (73.7% to 87.2%), though further optimization is warranted.
Why the study?
Does admission to a vascular surgery unit improve the prescribing rates of optimal medical therapy in vascular surgery patients?
Observational (n=244)
No
Does admission to a vascular surgery unit improve the prescribing rates of optimal medical therapy in vascular surgery patients?
Admission to a vascular surgery unit provides an opportunity to optimize cardiovascular medical therapy, though further improvements are needed particularly for ACEi/ARB and beta-blocker prescribing.
Answers are grounded in this paper and cite their sources.
Vascular admission was associated with improved antiplatelet and statin prescribing at discharge; leaves open whether targeted protocols close remaining gaps.
OBJECTIVE: Current clinical evidence reports that antiplatelet, statin, angiotensin-converting enzyme inhibitor and beta blockade therapies have advantageous effects on vascular surgery patient morbidity and mortality. Unfortunately, such patients appear to be less likely to receive optimal medical management when compared with coronary artery disease patients. This study assessed medical therapy prescribing in patients attending a regional vascular surgery unit. METHODS: A retrospective review between February 2010 and February 2011 was performed for patients undergoing aortic aneurysm, carotid, peripheral arterial and amputation surgeries. Gender, age, smoking history, body mass index and cardiovascular risk factors were documented from inpatient charts. Current admission medications and subsequent modification by the vascular team were recorded. RESULTS: Two hundred and forty-four patients (male = 165, mean age = 71 years) were identified. Prevalence of hypertension, hypercholesterolaemia, myocardial infarction, angina, stroke and diabetes was higher than in the general population. A total of 201 (82.3%) patients were on antiplatelets or antithrombotics upon admission to the vascular ward, which was improved to 231 (94.6%) patients on discharge. A total of 180 (73.7%) patients were on lipid-lowering therapy upon admission, which was improved to 213 (87.2%) patients on discharge. A total of 115 (47.1%) patients were on ACE-inhibitor or angiotensin 2 receptor blocker medications on admission and this was improved to 118 (48.3%) upon discharge. A total of 87 (35.6%) patients were on a beta-blocker, which was improved to 93 (38.1%) patients upon discharge. CONCLUSION: Despite increased implementation of best medical therapy in the community with compliance rates greater than 73% for aspirin and statin therapy, further improvement is warranted. Vascular surgeons should remain vigilant for further opportunities to optimise medical therapy in this high-risk patient group particularly with antithrombotic, lipid lowering and antihypertensive therapies.
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McGrogan et al. (2014) conducted an observational in Vascular surgery (n=244). Vascular surgery admission vs. Discharge was evaluated on Medical therapy prescribing rates (antiplatelets, lipid-lowering, ACE-inhibitors, beta-blockers). Vascular surgery admission led to improved prescribing rates by discharge for antiplatelets (82.3% to 94.6%) and lipid-lowering therapy (73.7% to 87.2%), though further optimization is warranted.
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