Prescription rate of anti-atherosclerotic drugs in German nursing homes and its impact on outcome
Abstract
Abstract.Background: Peripheral arterial disease (PAD) is one of the major manifestations of general atherosclerosis and strongly associated with increased cardiovascular morbidity and mortality. Because only few epidemiologic studies are available concerning the prevalence of PAD in inhabitants ≥ 80 years of age, we screened inhabitants of nursing care homes in Germany for PAD and cardiovascular diseases and to assess the one year mortality. Patients and methods: We conducted a prospective cohort study, screening inhabitants of 42 nursing homes for PAD. Demographic data, comorbidities, cardiovascular risk factors and daily medication were collected. PAD was defined as ankle-brachial index < 0.9. During a follow up period of one year, cardio- and cerebrovascular events and mortality were recorded, as well as the rate of falls and major amputation. Results: 1,329 probands (391 men, 938 women) > 60 years were eligible for further analysis. The mean age was 84.1 years (range 61–107 years) and the prevalence of PAD was 31.5 % . Media sclerosis was found in up to 17 %, and an existing diagnosis of PAD (in case of pathological ABI) and undertreatment was common. Probands with PAD were less likely to be treated according to guideline recommendations (antiplatelet therapy, beta blockers, statins) than probands with coronary artery disease (CAD). The overall one-year mortality was 19.8 % (n = 236), significantly higher than for a gender and age matched German population (p < 0.001). Conclusions: The current study shows a high prevalence of PAD in German nursing care homes. The one year mortality was not significantly different between probands with PAD and those with severe PAD (defined as an ABI of ≤ 0.5), whereas a media sclerosis was associated with an increased risk in probands with CAD in comparison to those without. Use of anti-diabetic agents and aspirin in monotherapy was associated with a reduced one-year mortality risk.
Keywords: Peripheral arterial disease, nursing care homes, coronary artery disease
Literature
Trifurcational disease and ischemic heart disease in intermittent claudication. Lancet. 1982; 1192–3.
.Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11): 1317–24.
The morbidity and mortality following a diagnosis of peripheral arterial disease: long-term follow-up of a large database. BMC Cardiovasc Disord. 2005;5:14.
.Regional Differences in the Prevalence of Cardiovascular Disease – Results from the German Health Update (GEDA) 2009–2012. Dtsch Arztebl Int. 2016;113(42):704–11.
.Annals of Internal Medicine Review The Ankle – Brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction Among Asymptomatic Adults: Ann Intern Med 2013;159(5): 333–41.
.Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991;20(2):384–92.
.Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med. 2000;160(19):2934–8.
.Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study. Am J Epidemiol. 2001;153(7):666–72.
.Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study. J Clin Epidemiol. 2004;57(3):294–300.
.Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32(4):328–33.
Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-year Results of the getABI Study. Cerebrovasc Dis. 2010;29:546–54.
Incidence of peripheral arterial disease in the ARTPER population cohort after 5 years of follow-up. BMC Cardiovasc Disord. 2016;16(1):8.
Patients with peripheral arterial disease in the CHARISMA trial. Eur Heart J. 2008;30(2):192–201.
Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care. JAMA J Am Med Assoc. 2001;286(11):1317–24.
Association of low ankle brachial index with high mortality in primary care. Eur Heart J. 2006;27(14):1743–9.
Epidemiologie der peripheren arteriellen verschlusskrankheit in Deutschland: Was ist gesichert und was ist offen? Hamostaseologie. 2006;26(3):193–6.
.Measurement and Interpretation of the Ankle-Brachial Index: A Scientific Statement From the American Heart Association. Circulation. 2012;126(24):2890–909.
AHA Conference Proceedings. Prevention conference V: Beyond secondary prevention: Identifying the high-risk patient for primary prevention: executive summary. American Heart Association. Circulation. 2015; 101(1):111–6.
.Statistisches Bundesamt Sterbetafeln Ergebnisse aus der laufenden Berechnung von. 2018;49(0).
.Sterbetafel 2012/2014, Methoden- und Ergebnisbericht zur laufenden Berechnung von Periodensterbetafeln für Deutschland und die Bundesländer. 2016;xx
.The prevalence and one-year outcome of limb arterial obstructive disease in a nursing home population. J Am Geriatr Soc. 1988 Jul;36(7): 607–12.
.Peripheral Artery Disease and Cardiovascular Risk Factors in the Elderly. Arterioscler Thromb Vasc Biol. 1996 Dec 1;16(12):1495 LP-1500.
Ankle-Arm Index as a Predictor of Cardiovascular Disease and Mortality in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol. 1999;19(3): 538–45.
Ethnicity and Peripheral Arterial Disease: The San Diego Population Study. Circulation. 2005;112(17):2703–7.
.Prevalence of abnormal ankle-brachial index among individuals with low or intermediate Framingham risk scores. J Vasc Interv Radiol. 2011;22(8):1077–82.
Secondary Prevention and Mortality in Peripheral Artery Disease: National Health and Nutrition Examination Study 1999–2004. Circulation. 2012;124(1): 17–23.
.A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. 2007;45(6): 1185–91.
Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. JAMA. 1993 Jul;270(4):487–9.
.Screening for peripheral artery disease using the ankle-brachial index: Updated evidence report and systematic review for the us preventive services task force. JAMA 2018 Jul 10;320(2):184–96.
.Indicators of outcome quality in peripheral arterial disease revascularisations – a Delphi expert consensus. Vasa. 2018;47:1–7.
Prevalence and incidence of cardiovascular disease in 1160 older men and 2464 older women in a long-term health care facility. J Gerontol A Biol Sci Med Sci. 2002;57(1):M45–6.
.Anand SS. Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: A systematic review. Arterioscler Thromb Vasc Biol. 2005;25(7): 1463–9.
,Duplex ultrasound of the superficial femoral artery is a better screening tool than ankle-brachial index to identify at risk patients with lower extremity atherosclerosis. J Vasc Surg. 2008;47(4):789–93.
.AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol. 2001;38(5):1581–3.
ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic). Circulation. 2006;113(11):e463–5.
Management of Peripheral Vascular Disease. Annu Rev Med. 2005;56(1):249–72.
.Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). Cancer. 2015;121(8): 1265–72.
.Lipid-lowering therapy in older persons. Arch Med Sci. 2015;11(1):43–56.
.Use of Medications of Questionable Benefit During the Last Year of Life of Older Adults With Dementia. J Am Med Dir Assoc. 2017;18(6):551.e1–551.e7.
.A Comparison of Clinical Outcomes Between Primary Bypass and Secondary Bypass After Failed Plain Balloon Angioplasty in the Bypass versus Angioplasty for Severe Ischaemia of the Limb (BASIL) Trial. Eur J Vasc Endovasc Surg. 2018;666–71.
.Pflegestatistik 2017. BESTSELLER – ein Magazin für die stationäre Pflege. 2017. Available from: http://bestseller-stationaer.de/pflegestatistik-2017-3.