Evidence-based medical treatment of peripheral arterial disease: A rapid review.
10.47102/annals-acadmedsg.2020649
- Author:
Sze Ling CHAN
1
;
Revvand RAJESH
;
Tjun Yip TANG
Author Information
1. Health Services Research Centre, SingHealth, Singapore.
- Publication Type:Journal Article
- From:Annals of the Academy of Medicine, Singapore
2021;50(5):411-424
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Peripheral arterial disease (PAD) treatment guidelines recommend the use of statins and antiplatelets in all PAD patients to reduce adverse cardiovascular and limb-related outcomes. In addition, hypertension and diabetes should be treated to reach recommended targets. The aim of this rapid review was to evaluate the level of adherence to evidence-based medical therapy (EBMT) recommended by PAD treatment guidelines in the real-world setting.
METHODS:We searched PubMed and Embase using keywords, MeSH and Emtree terms related to the population, exposure and outcomes from their inception to 22 September 2020. We included randomised controlled trials, non-randomised studies, and observational studies reporting adherence to at least 1 of these 4 drug classes: (1) statins, (2) antiplatelets, (3) antihypertensives and (4) antidiabetic drugs. Non-English articles, abstracts, dissertations, animal studies and case reports or series were excluded. A narrative summary of the results was performed.
RESULTS:A total of 42 articles were included in the review. The adherence to lipid-lowering drugs/statins ranged from 23.5 to 92.0% and antiplatelets from 27.5 to 96.3%. Only 7 and 5 studies reported use of "any anti-hypertensive" and "any anti-diabetic" medications, respectively, and the proportion of the cohort treated were generally close to the proportion with hypertension and/or diabetes. Adherence in studies published in 2016-2020 ranged from 52.4-89.6% for lipid-lowering drugs and 66.2-96.3% for antiplatelets.
CONCLUSION:EBMT adherence in PAD patients was highly variable and a substantial proportion in many settings were undertreated. There was also a notable lack of studies in Asian populations.
