Audit of Best medical Therapy for Arterial Referrals to Vascular clinic (ABTARV Study)
Background
There is strong evidence that patients with coronary atherosclerotic disease are at a high cardiovascular risk, and therefore require optimisation from a cardiac perspective including a minimum of an antiplatelet agent and a statin, treatment of hypertension, and diabetic control. Patients with peripheral arterial disease, abdominal aortic aneurysms or arterial ulceration also warrant secondary cardiovascular protection.
Aim
The aim of this audit is to determine the proportion of patients referred to vascular clinics with arterial disease who are on best medical therapy, through a multicentre audit of all patients seen in vascular clinic over a 3 month period from January 1st 2015 – March 31st 2015.
Methods
This audit aims to be conducted across several hospitals as a retrospective audit over a 3 month period. The audit will involve review of the referral letter, clinic letter, and any resultant imaging and blood results for each patient referred with a possible arterial problem. Data collected will include reason for referral, past medical history (including recent test for diabetes, MI, stroke, hypertension, cholesterol), smoking history, and current medications.
Inclusion criteria:
· New referral
· January 1st to March 31st 2015
· Any arterial referral (aneurysm, peripheral arterial disease, arterial ulcer)
Exclusion criteria:
· Patient previously seen in vascular clinic
· Non-arterial referral i.e. venous disease, hyperhidrosis, thoracic outlet syndrome
Audit of Best medical Therapy for Arterial Referrals to Vascular clinic (ABTARV Study)
ID:______Post Code ______Date of appt____\_____\______
Age ______
Reason for referral: Abdominal aortic aneurysm □ Arterial leg ulcer □
Claudication □ Necrosis □
Rest / night pain □ Other aneurysm □ (please state)______
Smoking history from GP: Current smoker (number per day) □ ______
Ex-smoker (number per day, age stopped) □ ______
Vaporiser □ (if so please indicate previous smoking) ______
Never smoker □
Past medical history:
Emphysema/COPD □ / Heart Attack □Angina □ / Coronary bypass grafts □
Stroke/TIA □ / Hypertension □
Diabetes □ / Peripheral vascular disease □
Amputation □ / Leg bypass graft / stent / angioplasty □
Has the patient had a recent (within 3 months) glucose, or diabetic test? Yes □ No □ ______
Has the patient had a recent (within 3 months) blood pressure check? Yes □ No □ ______
Is the patient on any of the following anticoagulation?
Aspirin □ / Clopidogrel □Warfarin □ / Other anticoagulant □
Has the patient had a reaction to anticoagulants, if so which one Yes □ No □ ______
Are they taking a statin, if so which one? And dose Yes □ No □ ______
Has the patient ever had a reaction to a statin? Yes □ No □ ______
Are you on any of the following medications?
ACE inhibitor (e.g. Ramipril/Perindopril) □ / Beta-blocker (e.g. atenolol/bisoprolol) □Diuretic (furosemide/bendrofluazide) □ / Calcium channel blocker (amlodipine) □
Metformin □ / Gliclazide □
Insulin □
Was the patient referred to a supervised exercise programme following this appointment? Yes □ No □
What was the patients’ ABPI? Symptomatic side______Asymptomatic/Less symptomatic side______
Did the patient have any imaging? CT Scan □ USS □ MRI □ Angiogram □
Did the imaging show evidence of arterial disease? Yes □ No □ ______
Has the patient subsequently had an intervention? Endovascular intervention □ Surgery □