Audit of general practitioners' referral policy and risk factor management in patients with intermittent claudication

Abstract

Aims: Intermittent claudication (IC) is common and patients have a risk of developing or dying from coronary heart disease equivalent to that of patients surviving their first myocardial infarction. The aim was to determine general practitioners’ (GPs) attitudes to referral, risk factor management and treatment in patients presenting with life-style limiting IC. Methods: Postal survey questionnaire of 334 GPs regarding smoking, exer- cise, antiplatelet therapy, diabetes and cholesterol. A similar survey was performed in 104 new clinic patients with IC. Results: A total of 242 (73 per cent) GPs responded. At initial patient presentation, 50 per cent would manage risk factors and reassess and 45 per cent would treat risk factors and refer directly to the clinic. Ninety per cent would prescribe aspirin, 99 per cent advise smoking cessation and 89 per cent advise increase in exercise. Blood glucose would be checked by 77 per cent and cholesterol by 85 per cent. The cholesterol levels (mmol L1 ) that GPs would treat are: <5, 5 per cent; >5, 36 per cent; >5.5, 18 per cent; >6, 23 per cent and 18 per cent would consider the patients’ overall risk factor profile. Initial management was diet alone in 70 per cent, statin in 30 per cent and 18 per cent had an age limit. In clinic patients, 62 per cent were prescribed aspirin, 81 per cent had an elevated cholesterol and less than half were on treatment. Conclusion: Cholesterol-lowering therapy is required in 80 per cent of claudicants, yet it is considered to be primary prevention by 18 per cent of GPs and the majority would only treat levels above 5.5 mmol L1 . Recent data suggests that claudicants should be treated with a statin irrespective of their cholesterol level, and thus national guidelines to ensure adequate secondary prevention of claudicants are urgently required.