Sunderland Melanie, De Jong Mandy, Bates Duane
, BScPharm, ACPR, was, at the time this study was performed, with the Foothills Medical Centre, Alberta Health Services, Calgary, Alberta. She is now a student in the PharmD program at the University of British Columbia, Vancouver, British Columbia.
Can J Hosp Pharm. 2013 Jul;66(4):227-32. doi: 10.4212/cjhp.v66i4.1270.
Patients with peripheral artery disease are 6 times as likely as healthy individuals to die of cardiovascular causes within 10 years after diagnosis. Combination therapy with a statin, an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), and an antiplatelet agent is recommended to reduce cardiovascular events in patients with peripheral artery disease, especially those with concomitant diabetes mellitus and those who have undergone vascular surgery.
The primary objective was to determine the proportion of patients with concurrent diabetes and peripheral artery disease who were receiving therapy with a statin, ACE inhibitor or ARB, and antiplatelet agent (acetylsalicylic acid or clopidogrel) at the time of discharge after vascular surgery. The secondary objectives were to determine if target blood pressure was achieved and if smoking cessation therapy was offered and/or provided.
This pilot study was a retrospective, cross-sectional chart analysis. The health records database for Alberta Health Services was searched to identify patients with diabetes who underwent vascular surgery at the Foothills Hospital in Calgary with discharge between January 1 and June 30, 2010. In addition to baseline demographic characteristics, blood pressure values at the time of admission and discharge were collected. Discharge medications, including cardiovascular medications such as statins, ACE inhibitor or ARB, and antiplatelet agents, were recorded. Descriptive analysis of the data was performed.
Of the 42 patients for whom charts were obtained, 25 (60%) had prescriptions for cardiovascular triple therapy (statin, ACE inhibitor or ARB, antiplatelet agent). Just over half of the patients (23 [55%]) had achieved target blood pressure (< 130/80 mm Hg) at the time of discharge. Of the 14 current smokers, 9 (64%) had documented evidence in the chart that smoking cessation counselling was offered and/or drug therapy was provided.
Only about half of the patients in this study were receiving cardiovascular triple therapy, which suggests that many patients were not receiving optimal vascular protection. A larger study is needed to review prescribing patterns for patients with peripheral artery disease.
外周动脉疾病患者在确诊后10年内死于心血管疾病的可能性是健康个体的6倍。推荐使用他汀类药物、血管紧张素转换酶（ACE）抑制剂或血管紧张素II受体阻滞剂（ARB）以及抗血小板药物进行联合治疗，以减少外周动脉疾病患者的心血管事件，尤其是合并糖尿病的患者以及接受过血管手术的患者。
主要目的是确定血管手术后出院时同时患有糖尿病和外周动脉疾病且正在接受他汀类药物、ACE抑制剂或ARB以及抗血小板药物（阿司匹林或氯吡格雷）治疗的患者比例。次要目的是确定是否达到目标血压，以及是否提供和/或实施了戒烟治疗。
这项初步研究是一项回顾性横断面图表分析。检索了艾伯塔省卫生服务局的健康记录数据库，以识别2010年1月1日至6月30日期间在卡尔加里山麓医院接受血管手术并出院的糖尿病患者。除了基线人口统计学特征外，还收集了入院时和出院时的血压值。记录了出院用药情况，包括他汀类药物、ACE抑制剂或ARB等心血管药物以及抗血小板药物。对数据进行了描述性分析。
在获取病历的42例患者中，25例（60%）有心血管三联疗法（他汀类药物、ACE抑制剂或ARB、抗血小板药物）的处方。略多于一半的患者（23例[55%]）在出院时达到了目标血压（<130/80 mmHg）。在14例当前吸烟者中，9例（64%）在病历中有记录表明提供了戒烟咨询和/或提供了药物治疗。
本研究中只有约一半的患者接受了心血管三联疗法，这表明许多患者没有得到最佳的血管保护。需要进行更大规模的研究来审查外周动脉疾病患者的用药模式。
