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dc.contributor.authorFroehlich, James B.
dc.contributor.authorMukherjee, Debabrata
dc.contributor.authorAvezum, Alvaro
dc.contributor.authorBudaj, Andrzej
dc.contributor.authorKline-Rogers, Eva M.
dc.contributor.authorLópez-Sendón, José
dc.contributor.authorAllegrone, Jeanna
dc.contributor.authorEagle, Kim A.
dc.contributor.authorMehta, Rajendra H.
dc.contributor.authorGoldberg, Robert J.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:44:05Z
dc.date.available2022-08-23T15:44:05Z
dc.date.issued2006-04-29
dc.date.submitted2011-09-23
dc.identifier.citationAm Heart J. 2006 May;151(5):1123-8. <a href="http://dx.doi.org/10.1016/j.ahj.2005.11.005">Link to article on publisher's site</a>
dc.identifier.issn0002-8703 (Linking)
dc.identifier.doi10.1016/j.ahj.2005.11.005
dc.identifier.pmid16644349
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27238
dc.description.abstractBACKGROUND: National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD. METHODS: Data were analyzed from 41,108 patients aged > or =18 years with ACS and enrolled in the large multinational GRACE between 1999 and 2004. RESULTS: Of the 41,108 patients, 4003 (9.7%) had prior PAD. Patients with PAD were older, more likely to be men, to have a variety of prior comorbidities, and to present with non-ST-segment elevation myocardial infarction and a higher Killip class than patients without PAD. Patients with PAD were less likely to be treated with effective cardiac medications than patients without PAD. At the time of hospital presentation, patients with prior PAD had low rates of use of beneficial cardiac medications, including angiotensin-converting enzyme inhibitors, aspirin, beta-blockers, and lipid-lowering agents. Patients with PAD were significantly more likely to experience the composite hospital end point (death, shock, recurrent angina, stroke) than patients without prior PAD (adjusted OR 1.17; 95% CI 1.08-1.26). CONCLUSIONS: Patients with prior PAD received less aggressive treatment with proven cardiac medications during hospitalization for an ACS than patients without PAD. Utilization of beneficial medical therapies in patients with PAD before hospitalization with ACS was also less than optimal. Given the poorer hospital outcomes in patients with PAD, our findings suggest considerable opportunity to improve care for these high-risk patients.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=16644349&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.ahj.2005.11.005
dc.subjectAcute Disease
dc.subjectAged
dc.subject*Arteries
dc.subjectCase-Control Studies
dc.subjectCoronary Disease
dc.subjectFemale
dc.subjectHospitalization
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPeripheral Vascular Diseases
dc.subjectRegistries
dc.subjectTreatment Outcome
dc.subjectHealth Services Research
dc.titleAssociation of peripheral artery disease with treatment and outcomes in acute coronary syndromes. The Global Registry of Acute Coronary Events (GRACE)
dc.typeJournal Article
dc.source.journaltitleAmerican heart journal
dc.source.volume151
dc.source.issue5
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/58
dc.identifier.contextkey2254979
html.description.abstract<p>BACKGROUND: National guidelines recommend the use of secondary prevention modalities for patients with peripheral artery disease (PAD) and coronary artery disease. The effect of prior PAD on the treatment and outcomes of patients with acute coronary syndromes (ACS), however, is not well characterized. The objectives of this study were to assess treatment practices and hospital outcomes in patients with ACS and prior PAD.</p> <p>METHODS: Data were analyzed from 41,108 patients aged > or =18 years with ACS and enrolled in the large multinational GRACE between 1999 and 2004.</p> <p>RESULTS: Of the 41,108 patients, 4003 (9.7%) had prior PAD. Patients with PAD were older, more likely to be men, to have a variety of prior comorbidities, and to present with non-ST-segment elevation myocardial infarction and a higher Killip class than patients without PAD. Patients with PAD were less likely to be treated with effective cardiac medications than patients without PAD. At the time of hospital presentation, patients with prior PAD had low rates of use of beneficial cardiac medications, including angiotensin-converting enzyme inhibitors, aspirin, beta-blockers, and lipid-lowering agents. Patients with PAD were significantly more likely to experience the composite hospital end point (death, shock, recurrent angina, stroke) than patients without prior PAD (adjusted OR 1.17; 95% CI 1.08-1.26).</p> <p>CONCLUSIONS: Patients with prior PAD received less aggressive treatment with proven cardiac medications during hospitalization for an ACS than patients without PAD. Utilization of beneficial medical therapies in patients with PAD before hospitalization with ACS was also less than optimal. Given the poorer hospital outcomes in patients with PAD, our findings suggest considerable opportunity to improve care for these high-risk patients.</p>
dc.identifier.submissionpathcor_grace/58
dc.contributor.departmentDepartment of Medicine, Division of Cardiovascular Medicine
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages1123-8


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