Journal of Public Health

, Volume 18, Issue 6, pp 523–532 | Cite as

Outcomes of medical management of peripheral arterial disease in general practice: follow-up results of the PACE-PAD Study

  • Anja Neumann
  • Rebecca Jahn
  • Curt Diehm
  • Elke Driller
  • Franz Hessel
  • Gerald Lux
  • Oliver Ommen
  • Holger Pfaff
  • Uwe Siebert
  • David Pittrow
  • Jürgen Wasem
  • on behalf of the Patient Care Evaluation-Peripheral Arterial Disease (PACE-PAD) Study Investigators
Original Article
  • 78 Downloads

Abstract

Aim

Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not.

Methods

The Patient Care Evaluation-Peripheral Arterial Disease Study (PACE-PAD) was a multicenter, cluster randomized, prospective, longitudinal cohort study of patients with PAD in primary care, who were followed up for death or vascular events over 18 months. Guideline orientation was assumed if patients received anticoagulant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively.

Results

Of the 5,099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% male subjects) who were followed up, 22.5, 34.6, 30.1, 7.8, and 3.5% (1.5% not specified) were in Fontaine stages I, IIa, IIb, III, and IV. Comprehensive guideline orientation was reported in 28.4% only; however, patients in lower Fontaine stages received guideline-oriented therapy more often (I: 30.3%, IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had unstable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines and those who were not.

Conclusion

The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and non-guideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, and patient’s noncompliance with therapy.

Keywords

Guideline orientation Peripheral arterial disease Outcomes Intermittent claudication Observational study 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Anja Neumann
    • 1
  • Rebecca Jahn
    • 1
  • Curt Diehm
    • 2
  • Elke Driller
    • 3
  • Franz Hessel
    • 1
  • Gerald Lux
    • 1
  • Oliver Ommen
    • 3
  • Holger Pfaff
    • 3
  • Uwe Siebert
    • 4
  • David Pittrow
    • 5
  • Jürgen Wasem
    • 1
  • on behalf of the Patient Care Evaluation-Peripheral Arterial Disease (PACE-PAD) Study Investigators
  1. 1.Alfred Krupp von Bohlen und Halbach-Stiftungslehrstuhl für Medizin-ManagementUniversität Duisburg-EssenEssenGermany
  2. 2.Klinikum Karlsbad-LangensteinbachKarlsbadGermany
  3. 3.Zentrum für VersorgungsforschungUniversität zu KölnCologneGermany
  4. 4.Department of Public Health, Medical Decision Making and Health Technology AssessmentUniversity for Health Sciences, Medical Informatics and Technology (UMIT)HallAustria
  5. 5.Institute for Clinical Pharmacology, Medical Faculty Carl Gustav CarusTechnical UniversityDresdenGermany

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