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Canadian Journal of Public Health

, Volume 101, Issue 1, pp 96–100 | Cite as

Protective Vascular Treatment of Patients with Peripheral Arterial Disease: Guideline Adherence According to Year, Age and Gender

  • Mariane PâquetEmail author
  • Danielle Pilon
  • Jean-Pierre Tétrault
  • Nathalie Carrier
Quantitative Research 2009 Student Award Winner
  • 1 Downloads

Abstract

Objectives

To evaluate vasoprotective pharmacological treatment of patients with peripheral arterial disease (PAD) according to: 1) year, 2) age and 3) gender.

Methods

An observational retrospective study was conducted to evaluate the systemic vascular treatment of a population-based cohort of patients with PAD ≥50 years old, discharged from a tertiary-care teaching hospital between January 1, 1997 and December 11, 2006. Data were obtained from the Régie de l’assurance maladie du Québec. Drugs evaluated included antiplatelet agents (APs), statins (STs) and angiotensin converting enzyme inhibitors (ACEIs), and a combination of all three. Proportions of patients treated were compared according to year, age and gender using Chi-square.

Results

The mean age of the study population (5962 individuals) was 73.2 ± 9.1 years; 43.8% were women. After hospital discharge, 71.6%, 47.6%, 42.2% and 20.6% were taking respectively, an AP, statin, ACEI or all three. Protective treatment improved significantly from 1997 to 2006. Significantly more subjects 50–64 years used a statin or all three agents, compared to subjects ≥65 years (statins: 56.6% vs. 45.8%, all three: 26.2% vs. 19.5%; p<0.001). Significantly more men than women used statins (49.1% vs. 45.6%; p<0.001) and ACEIs (44.5% vs. 39.3%; p<0.001). Similarily, use of all three agents was 22.4% for men and 18.2% for women (p<0.001).

Conclusions

Although systemic vascular treatment received by patients with PAD has increased in the past years, it remains suboptimal, particularly for older patients and women. Strategies to improve adherence to treatment guidelines should be developed for these high-risk populations.

Keywords

Peripheral arterial disease secondary prevention guideline adherence 

Résumé

Objectifs

Évaluer l’utilisation du traitement pharmacologique vasoprotecteur de patients atteints de la maladie vasculaire artérielle périphérique (MVAP) et plus spécifiquement comparer le traitement selon: 1) l’année, 2) l’âge et 3) le sexe.

Méthode

Nous avons mené une étude observationnelle rétrospective pour évaluer le traitement vasoprotecteur d’une cohorte de patients de ≥50 ans atteints de la MVAP, ayant reçu leur congé d’un hôpital universitaire tertiaire entre le 1er janvier 1997 et le 11 décembre 2006. Les données ont été obtenues de la Régie de l’assurance maladie du Québec. Le traitement pharmacologique évalué incluait l’utilisation d’antiplaquettaires (AP), de statines (ST), d’inhibiteurs de l’enzyme de conversion de l’angiotensine (IECA) et des trois à la fois. Les proportions de patients traités étaient comparées selon le temps, l’âge et le sexe à l’aide du test du khi-carré.

Résultats

L’âge moyen de la population (n=5 962) était de 73,2 ± 9,1 ans, dont 43,8% de femmes. Après le congé hospitalier, respectivement 71,6%, 47,6%, 42,2% et 20,6% prenaient un antiplaquettaire, une statine, un IECA ou les trois agents. L’utilisation du traitement vasoprotecteur augmente significativement de 1997 à 2006. Plus de patients jeunes, de 50–64 ans, utilisent une ST ou les trois agents simultanément comparativement aux patients de ≥65 ans (statine: 56,6% comparativement à 45,8%, les trois: 26,2% comparativement à 19,5%; p<0,001). Significativement plus d’hommes que de femmes utilisaient une ST (49,1% contre 45,6%; p<0,001) et un IECA (44,5% contre 39,3%; p<0,001). De façon similaire, 22,4% d’hommes comparativement à 18,2% de femmes utilisaient les trois agents en même temps (p<0,001).

Conclusions

Malgré une amélioration dans les dernières années, l’utilisation du traitement vasoprotecteur des patients atteints de MVAP demeure sous-optimal, particulièrement en ce qui concerne les femmes et les personnes âgées. Des stratégies pour augmenter l’adhésion aux recommandations émises pour le traitement vasoprotecteur de ces personnes à haut risque vasculaire devraient être élaborées.

Motsclés

maladies vasculaires périphériques prévention secondaire adhésion aux directives 

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Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Mariane Pâquet
    • 1
    • 2
    Email author
  • Danielle Pilon
    • 1
    • 3
  • Jean-Pierre Tétrault
    • 4
  • Nathalie Carrier
    • 5
  1. 1.Centre de recherche sur le vieillissementInstitut universitaire de gériatrie de SherbrookeSherbrookeCanada
  2. 2.Département de médecine sociale et préventiveUniversité de MontréalMontréalCanada
  3. 3.Département de médecine interneUniversité de SherbrookeSherbrookeCanada
  4. 4.Département d’anesthésiologieUniversité de SherbrookeSherbrookeCanada
  5. 5.Centre de recherche clinique Étienne-Le BelCentre hospitalier universitaire de SherbrookeSherbrookeCanada

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