- Vascular Support
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by tmi
Guideline neglect observed for limb ischemia
U.S. study uncovers substandard care for patients facing amputation
WRITTEN BY ED SUSMAN ON FEBRUARY 27, 2012 FOR CANADIANHEALTHCARENETWORK.CA
MIAMI BEACH, FLA. | Despite recommendations that patients at risk of amputation be referred to vascular surgeons, barely one-third of doctors at one institution complied with those guidelines.
But a review of patients’ charts also found the recommendation was just one of many American Heart Association/American College of Cardiology recommendations for patients with chronic critical limb ischemia that had poor compliance, according to Dr. Laura Harmon, a surgery resident at Scott & White Hospital in Temple, Texas. She conducted the retrospective study at Texas Tech University Health Sciences Center in Odessa.
“Only 36% of our patients in this study got beyond the primary caregiver,” Dr. Harmon said at her poster presentation during the 2012 International Symposium on Endovascular Therapy here. “The problem is not that our facilities are isolated and don’t have specialists available. We are just not getting the referrals to the appropriate people.”
Dr. Harmon and colleagues reviewed cases of lower limb amputation from 2006 to 2010 to determine how well doctors were doing at following the 2005 guidelines.
She found that of the 314 patients in the study:
• 26% were referred to institutional smoking cessation programs
• 32% had surgical revascularization procedures
• 34% underwent assessment of additional ischemic risk factors
• 34% had endovascular revascularization procedures
• 36% were referred to a vascular specialist
• 38% were on statin prescriptions
• 39% were given hemodynamic diagnostic studies
• 56% were given prescriptions for antiplatelet therapy
• 59% had imaging studies to define underlying vascular anatomy.
“Despite the guidelines for lower extremity arterial disease management, a substantial gap exists between current recommendations and clinical practice,” Dr. Harmon said. “Our goal in performing this study was to bring some attention to this situation in our home facility and say: ‘Hey, we are not doing this right.’”
She said plans are in place to determine if greater compliance with guidelines can be achieved through the education of physicians and allied health-care professionals.
But a review of patients’ charts also found the recommendation was just one of many American Heart Association/American College of Cardiology recommendations for patients with chronic critical limb ischemia that had poor compliance, according to Dr. Laura Harmon, a surgery resident at Scott & White Hospital in Temple, Texas. She conducted the retrospective study at Texas Tech University Health Sciences Center in Odessa.
“Only 36% of our patients in this study got beyond the primary caregiver,” Dr. Harmon said at her poster presentation during the 2012 International Symposium on Endovascular Therapy here. “The problem is not that our facilities are isolated and don’t have specialists available. We are just not getting the referrals to the appropriate people.”
Dr. Harmon and colleagues reviewed cases of lower limb amputation from 2006 to 2010 to determine how well doctors were doing at following the 2005 guidelines.
She found that of the 314 patients in the study:
• 26% were referred to institutional smoking cessation programs
• 32% had surgical revascularization procedures
• 34% underwent assessment of additional ischemic risk factors
• 34% had endovascular revascularization procedures
• 36% were referred to a vascular specialist
• 38% were on statin prescriptions
• 39% were given hemodynamic diagnostic studies
• 56% were given prescriptions for antiplatelet therapy
• 59% had imaging studies to define underlying vascular anatomy.
“Despite the guidelines for lower extremity arterial disease management, a substantial gap exists between current recommendations and clinical practice,” Dr. Harmon said. “Our goal in performing this study was to bring some attention to this situation in our home facility and say: ‘Hey, we are not doing this right.’”
She said plans are in place to determine if greater compliance with guidelines can be achieved through the education of physicians and allied health-care professionals.