ACE up the sleeve - are vascular patients medically optimized?

Abstract

Objective: To examine the current medical management of arteriopathic patients attending a vascular surgical service at a university teaching hospital over a 6-month period. The prescribing of antiplatelets, statins, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers and beta-blockers was specifically examined. Vascular patients are often under the care of multiple specialties, and therefore the influence of different medical specialties on the patients' medical management was also examined.

Design: Between January and June 2009, data were recorded on sequential patients with arterial disease attending the vascular surgical service. Patients' demographics, type of arterial disease, medical consultations within the previous 12 months, and current medications were recorded.

Results: The study included 180 patients with a mean age of 69 years (39-88 years). All but 4% were taking an antiplatelet or anticoagulant, predominantly aspirin. There were 86% taking a statin, 44% taking a beta-blocker, and 51% taking an ACE inhibitor. Suboptimal prescription of ACE inhibitors and beta-blockers was evident regardless of the type of medical consultations in the previous year. No specialty group differed significantly from vascular surgeons in their prescribing pattern.

Conclusions: While almost all arteriopaths receive some form of antiplatelet and statin in line with clinical evidence, ACE inhibitors and beta-blockers appear to be under-prescribed in this arteriopathic population. We conclude that opportunity exists for vascular surgeons to embrace recent guidelines and lead the way in both surgical and medical optimization of arteriopathic patients through improving links with primary care physicians or taking greater responsibility themselves for the medical as well as the surgical care of their arteriopathic patients.

Keywords: ACE inhibitors; arteriopathic disease; beta-blockers; statins; vascular disease.

Figure 1

Percentage of study population using individual medications. Note: *Including ARBs. Abbreviations: ARB, angiotensin-receptor blockers; ACE, angiotensin-converting enzyme.

Figure 2

Percentage of patients reviewed by each specialty in previous 12 months.

Figure 3

Modified Venn diagram representing the subgroups per specialty seen in the previous 12 months. Abbreviation: GP, general practice.

Figure 4

Percentage of patients on different medications per specialty groups. Notes: Black, statins; gray, beta-blockers; white, ACE inhibitors (or ARBs). Abbreviations: ARB, angiotensin-receptor blockers; ACE, angiotensin-converting enzyme.