Mortality in Peripheral Arterial Disease: A Comparison of Patients Managed by Vascular Specialists and General Practitioners |
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Authors: | Gregorio Brevetti Gabriella Oliva Giuseppe Giugliano Vittorio Schiano Julieta Isabel De Maio Massimo Chiariello |
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Institution: | (1) Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Napoli “Federico II”, Naples, Italy;(2) Via G. Iannelli 45/A, 80131 Naples, Italy |
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Abstract: | BACKGROUND Peripheral arterial disease (PAD) is undertreated by general practitioners (GPs). However, the impact of the suboptimal clinical
management is unknown.
OBJECTIVE To assess the mortality rate of PAD patients in relation to the type of physician who provides their care (GP or vascular
specialist).
DESIGN Prospective study.
SETTING Primary care practice and academic vascular laboratory.
PARTICIPANTS GP patients (n = 60) were those of the Peripheral Arteriopathy and Cardiovascular Events study (PACE). Patients managed by specialists (n = 82) were consecutive subjects with established PAD who were referred to our vascular laboratory during the enrolment period
of the PACE study.
MEASUREMENTS All-cause and cardiovascular mortality.
RESULTS After 32 months of follow-up, specialist management was associated with a lower rate of all-cause mortality (RR = 0.04; 95%
CI 0.01–0.34; p = .003) and cardiovascular mortality (RR = 0.07; 95% CI 0.01–0.65; p = .020), after adjustment for patients’ characteristics. Specialists were more likely to use antiplatelet agents (93% vs
73%, p < .001), statins (62% vs 25%, p < .001) and beta blockers (28% vs 3%, p < .001). Survival differences between specialists and GPs disappeared once the use of pharmacotherapies was added to the
proportional hazard model. The fully adjusted model showed that the use of statins was significantly associated with a reduced
risk of all-cause mortality (RR = 0.02; 95% CI 0.01–0.73, p = .034) and cardiovascular mortality (RR = 0.02; 95% CI 0.01–0.71, p = .033).
CONCLUSIONS Specialist management of patients with symptomatic PAD resulted in better survival than generalist management. This effect
appears to be mainly caused by the more frequent use of effective medicines by specialists. |
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Keywords: | peripheral arterial disease mortality vascular specialists general practitioners |
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