Characteristics and treatment of patients with intermittent claudication. A comparison between UK and Maltese populations

Abstract

Background: Intermittent claudication (IC) is the most common symptom of peripheral arterial disease (PAD). It is strongly associated with an increased risk of myocardial infarction, stroke and cardiovascular mortality by up to 4 times greater than in patients without IC. Over the years effort has been made within the health sector to raise awareness of the cardiovascular risk factors present inpatients with PAD. However, a prospective registry of patients was still lacking. Therefore, a prospective registry of PAD risk factors, events and peripheral perfusion of patients with IC referred from primary care to specialist vascular clinics was undertaken. Baseline characteristics and treatments were compared to previously published UK data (PREPARED-UK). This information may provide a point of reference by which future health practices may potentially improve. Methods: A cross-sectional observational study was conducted, where all patients referred to a Vascular Clinic in a local hospital over 12 months, due to IC were invited to participate. Individuals who gave informed consent to participate were assessed for PAD by hemodynamic analysis. A full medical history including previous cardiac events or stroke, medications taken and associated participant demographics were noted. Results were compared to PREPARED-UK data. Results: A total of 150 consecutive participants were recruited. These included all the patients referred to the specialist vascular clinic from primary care GP clinics. The main demographic characteristics of enrolled participants indicate that the two populations are similar in age, BMI, smoking status and anti-platelet therapy. However, a much higher prevalence of hyperlipidaemia (HLD), diabetes, hypertension (HTN) and statin use is observed in the Maltese prospective registry compared to data published by in the PREPARED-UK registry (HLD 78.4% vs 43.1%, Diabetes 66.2% vs 20.1%, HTN 84% vs 55.4%, statins 76% vs 40% respectively). Conclusion: Our findings indicate a distinct difference in prevalence of important cardiovascular risk factors between the two populations. Hypertension, hyperlipidaemia and diabetes have been linked with a 7-fold increased risk of having a cardiovascular vascular event. However, similar to the UK population, about one third of the patients were not prescribed anti-platelet medication or statins. Despite the Consensus Report stating that antiplatelet therapy should be used routinely in PAD, with aspirin as the first line treatmF25ent, patients are still poorly managed prior to referral to the vascular specialist indicating an underestimation of the serious nature of the disease. Therefore, more referrals by primary health GPs to podiatrists for vascular assessment are required, so that once PAD is diagnosed immediate referral for risk factor management is undertaken. Additionally, follow-up of these patients would help to ensure that important risk factors are being managed while also monitoring PAD status.