Audit of Best Medical Therapy for Referrals to Vascular Clinic P Stather, F Muscara, On behalf of the VERN Collaborators* *C Nesbitt, D McCretton, J Shalhoub, A Copland, A Busuttil, R Bootun, S Onida, A Skinner, N Dattani, L Omotolani, R Edmonds, Z Koshnow, A Tsui, M O’Connell, A Duncan, J Blackwell, F Muscara, P Stather, Rozelle Kane, P Brooke, D Sidloff, A Saratzis, D Bosanquet, R Benson, J Pancholi

Background Increased Cardiovascular Risk Worse than a history of MI

Guidelines Aim To determine adherence to cardiovascular risk reduction guidelines in arterial referrals to vascular clinic Antiplatelet Agent Statin Therapy (Atorvastatin 80mg) Smoking Cessation Blood Pressure Control Lifestyle Modification

Methods Results 656 patients Median age 70.9 years Data collected Multicentre audit Promoted through VERN Retrospective review Patients attending vascular clinic Aneurysm, Carotid, Peripheral Arterial Disease 656 patients Median age 70.9 years Reason for Referral Data collected Age Medications Cardiovascular risk factors Smoking status BMT component Percentage Current Smoker 27.4% Antiplatelet 59.2% Statin 61.5% Tested for Diabetes 31.9% BP Check 61.3% Both Antiplatelet and Statin 47.3% Antiplatelet, Statin, Not Smoker 34.3%

Results BMT Component AAA PAD P Value Current Smoker 27.5% 41.4% 0.01 Antiplatelet 57.8% 60.5% NS Statin 56.3% 58.8% Tested for Diabetes 3.8% 14.3% <0.001 BP Check 20.8% 39.4% <0.01 BMT Component Stroke/TIA N=65 Cardiac Hx N=173 Hypertension N=293 Diabetes N=167 No Other Risk Factors N=233 Current Smoker 26.2% 20.8% 24.9% 19.2 35.6% Antiplatelet 72.3% 84.4% 67.6% 77.2% 46.8% Statin 67.7% 76.3% 70.0% 76.0% 37.8% Both Meds 53.8% 55.6% 65.9% 29.2% All 3 40.0% 54.3% 42.0% 53.3% 17.6% BMT Component 0 Risk Factors N=233 1 Risk Factor N=217 2 Risk Factors N=143 3/4 Risk Factors N=63 Current Smoker 35.6% 23.0% 23.6% 20.6% Antiplatelet 46.8% 57.6% 77.8% 88.9% Statin 37.8% 66.4% 70.1% 84.1% Both Meds 29.2% 47.0% 63.2% All 3 17.6% 35.5% 46.5% 63.5%

Conclusions Less than half of patients referred to vascular clinic are on best medical therapy Significant numbers have not had diabetic or BP checks Smoking cessation advice is still necessary The more cardiac risk factors present the better we get at initiating best medical therapy Recommendations National drive to highlight vascular disease as a significant cardiac risk factor Referral protocols reminding General Practitioners to start BMT, check DM and BP and offer smoking cessation

Many thanks to our Collaborators Craig Nesbitt David McCretton Joe Shalhoub Alex Coupland Andrew Busuttil Roshan Bootun Sarah Onida Alex Skinner Lewis Omotolani Nikesh Dattani Ruth Edmonds Znar Koshnow Adrian Tsui Megan O’Connell Andrew Duncan James Blackwell Francesca Muscara Rozelle Kane Philip Stather Peter Brooke David Sidloff Athanasios Saratzis Dave Bosanquet Ruth Benson Wrexham Maelor Hospital Royal Gwent Hospital