1. 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

2. Background
Increased Cardiovascular Risk
Worse than a history of MI

3. 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

4. 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%

5. 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%

6. 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

7. 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