Kinikini Daniel, Sarfati Mark R, Mueller Michelle T, Kraiss Larry W
Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City 84132-2301, USA.
J Vasc Surg. 2006 Apr;43(4):781-7. doi: 10.1016/j.jvs.2005.12.002.
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.
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.
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.
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.
为降低心血管疾病死亡率，患有动脉粥样硬化性疾病的患者应根据美国心脏协会/美国心脏病学会（AHA/ACC）二级预防指南（以下简称指南）进行危险因素修正。我们评估了一组血管外科门诊患者对该指南的依从性。
我们评估了一所大学血管外科门诊连续收治的200例下肢闭塞性疾病、脑血管疾病或腹主动脉瘤患者。研究对象包括曾在我们诊所就诊过的患者（已就诊患者）和新转诊患者（新患者）。通过患者访谈、用药史和实验室记录收集与AHA/ACC指南九个目标相关的数据。评估对每个指南目标的依从性。同时比较已就诊患者组和新患者组在依从性上的差异。我们还记录了患者既往是否接受过血管腔内或开放性血管手术干预（有事件或无事件）。比较有事件组和无事件组在依从性上的差异。
大多数患者未达到指南中推荐的二级预防目标。既往有血管干预（有事件）的患者更有可能达到低密度脂蛋白水平（43%对23%）、他汀类药物（71%对39%）、β受体阻滞剂（46%对27%）、血管紧张素转换酶抑制剂（53%对35%）以及抗血小板药物使用（85%对68%）的目标（P <.05）。已就诊患者比新患者更有可能有既往有事件（87%对47%，P <.0005）。已就诊患者比新患者更有可能达到低密度脂蛋白水平、β受体阻滞剂和他汀类药物使用的目标；然而，这些差异可能是由于已就诊患者组中有事件患者的比例较高。
动脉粥样硬化性疾病患者对指南的依从性欠佳。有事件患者组更常达到二级预防目标，这表明血管干预可能会提高患者和医生对指南的认识及依从性。针对动脉粥样硬化性疾病患者进行有针对性的危险因素修正工作，可能会提高对指南的依从性并降低心血管疾病死亡率。
