Improving outcomes in patients with peripheral arterial disease.
The benefits of risk-factor reduction associated with peripheral arterial disease (PAD) is established and supported by the literature. The purpose of this quality-improvement project was to reduce modifiable risk factors such as diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), and tobacco use in patients with PAD, as well as to demonstrate improvement in quality of life (QoL) and 6-minute-walk distances. For this quality-improvement project, 29 patients from three providers within a cardiology office were identified over a 6-week period. Those patients had a baseline 6-minute-walk test and completed a vascular quality-of-life (Vas QoL-6) questionnaire at visit 1. They were assessed for their Rutherford classification, a clinical staging system used to describe PAD. In visit 2, patients underwent endovascular intervention as per cardiologist recommendation. At clinic visit 3, an individualized plan was initiated to address all risk factors including diabetes mellitus, hypertension, hyperlipidemia, and tobacco use. Medications were adjusted to meet current guidelines appropriate for disease processes. Patients were also asked to start a regimented walking program as used by the Cleveland Clinic. At clinic visit 4, 90 days from patient's first visit, they were assessed for improvement in blood pressure, cholesterol, diabetes, and tobacco use. Vas QoL-6 and 6-minute-walk test were repeated at visit 4 for comparison. A total of 24 participants were included in the study. The average age was 66.92 years (standard deviation = 8.75), and the majority reported their race as white (n = 18, 75.0%). There were 10 (41.7%) males and 14 (58.3%) females. No statistically significant improvement was shown for A1c levels (P = .091) and total cholesterol (P = .066). Statistically significant improvement was revealed for low-density lipoprotein cholesterol (P = .007). Of the seven patients (29.2%) who used tobacco at visit 3, four (57.1%) reported a reduction in their tobacco use by the end of the study. Vas QoL-6 scores improved significantly (P < 0.001), and the distance during 6-minute walk also increased significantly (P = 0.03). There was a statistically significant decrease in Rutherford class scores from visit 1 to visit 4 (P < .001). Regarding compliance with the PAD Walking Program, 13 (54.2%) of the patients walked 10 or fewer times total. In conclusion, these data indicate that PAD risk factors can be improved, including control of blood pressure, cholesterol, A1c levels, and smoking cessation. Controlling risk factors that contribute to the progression of PAD is not only important for improving morbidity and mortality but may contribute to improved quality of life. This quality-improvement study also suggests that close follow-up and management after endovascular intervention increases the distance patients can ambulate without claudication symptoms. These results suggest that compliance with an unsupervised walking program is difficult, and supervised exercise programs should be considered as an alternative.
Sutton, M; Kreider, K; Thompson, J; Germanwala, S; Greifenkamp, J
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