Vascular protection in patients with diabetes admitted for vascular surgery in a Canadian tertiary care hospital: Pilot study

Abstract

Background: 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. Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.