Published Online
on April 24, 2009

A more recent version of this article appeared on July 1, 2009

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Original Article

Medication Underuse During Long-Term Follow-Up in Patients With Peripheral Arterial Disease

Sanne E. Hoeks, MSc; Wilma J.M. Scholte op Reimer, PhD; Yvette R.B.M. van Gestel, MSc; Olaf Schouten, MD; Mattie J. Lenzen, PhD; Willem-Jan Flu, MD; Jan-Peter van Kuijk, MD; Corine Latour, PhD; Jeroen J. Bax, MD; Hero van Urk, MD and Don Poldermans, MD

From the Departments of Anesthesiology (S.E.H., Y.R.B.M.v.G., W.-J.F., J.-P.v.K., D.P.), Vascular Surgery (O.S., H.v.U.), and Cardiology (M.J.L.), Erasmus Medical Center, Rotterdam, The Netherlands; Amsterdam University of Applied Sciences (W.J.M.S.o.R., C.L.), School of Nursing, Amsterdam, The Netherlands; and the Department of Cardiology (J.J.B.), Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to Don Poldermans, MD, PhD, Erasmus Medical Center, Room H805, s-Gravendijkwal 230, 3015 GD Rotterdam, The Netherlands. E-mail d.poldermans{at}erasmusmc.nl

Background: Patients with peripheral arterial disease constitute a high-risk population. Guideline-recommended medical therapy use is therefore of utmost importance. The aims of our study were to establish the patterns of guideline-recommended medication use in patients with PAD at the time of vascular surgery and after 3 years of follow up, and to evaluate the effect of these therapies on long-term mortality in this patient group.

Methods and Results: Data on 711 consecutive patients with peripheral arterial disease undergoing vascular surgery were collected from 11 hospitals in the Netherlands (enrollment between May and December 2004). After 3.1±0.1 years of follow-up, information on medication use was obtained by a questionnaire (n=465; 84% response rate among survivors). Guideline-recommended medical therapy use for the combination of aspirin and statins in all patients and β-blockers in patients with ischemic heart disease was 41% in the perioperative period. The use of perioperative evidence-based medication was associated with a reduction of 3-year mortality after adjustment for clinical characteristics (hazard ratio, 0.65; 95% CI, 0.45 to 0.94). After 3 years of follow-up, aspirin was used in 74%, statins in 69%, and β-blockers in 54% of the patients respectively. Guideline-recommended medical therapy use for the combination of aspirin, statins, and β-blockers was 50%.

Conclusions: The use of guideline recommended therapies in the perioperative period was associated with reduction in long-term mortality in patients with peripheral arterial disease. However, the proportion of patients receiving these evidence-based treatments-both at baseline and 3 years after vascular surgery-was lower than expected based on the current guidelines. These data highlight a clear opportunity to improve the quality of care in this high-risk group of patients.