Randomized Trial of a Vascular Care Team vs Education for Patients With Peripheral Artery Disease.
Document Type
Article
Publication Title
Journal of the American College of Cardiology
Abstract
BACKGROUND: Underutilization of therapies to reduce ischemic risk in peripheral artery disease (PAD) persists.
OBJECTIVES: The purpose was to conduct an implementation trial of lipid management in vascular disease.
METHODS: The OPTIMIZE PAD-1 (Implementation of Vascular Care Team to Improve Medical Management of PAD Patients) trial randomized patients with peripheral artery disease with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL to management via a vascular care team including a clinical pharmacist and an algorithm of intensive lipid management to achieve goal LDL-C in 1 step vs usual care plus provider education. Medications were obtained using commercial insurance. The primary endpoint was percent change in LDL-C at 12 months.
RESULTS: Of 166 enrolled patients, 74.2% did not have an LDL-C level at goal. Among 114 randomized patients (mean age 66 years, 36.0% women, and 15.8% Black), 50.9% received high-intensity statin, and 7.9% received ezetimibe at baseline. The mean 12-month LDL-C change was -49.1% (95% CI: -58.7% to -39.5%) with vascular care team management and -5.4% (95% CI: -15.3% to 4.6%) with usual care; the between-group least-squares mean difference was -43.7% (95% CI: -57.6% to -29.9%; P < 0.0001). Mean LDL-C was reduced in vascular care team patients from 100.6 mg/dL at baseline to 54.8 and 50.1 mg/dL by week 4 and month 12, respectively. At 12 months, vascular care team patients were >3 times as likely to achieve LDL-C/dL and 8 times as likely to achieve LDL-C/dL (P < 0.0001) than usual care.
CONCLUSIONS: OPTIMIZE PAD-1 showed that an interprofessional, algorithm-based program can achieve rapid LDL-C lowering in vascular patients using available insurance and therapies, and LDL-C targets can be met in most patients if enabled by optimized systems of care.
First Page
2658
Last Page
2670
DOI
10.1016/j.jacc.2024.04.034
Publication Date
6-25-2024
Recommended Citation
Hess, Connie N; Daffron, Ashley; Nehler, Mark R; Morrison, Justin T; Buchanan, Cullen E; Szarek, Michael; Anderson, Victoria E; Cannon, Christopher P; Hsia, Judith; Saseen, Joseph J; and Bonaca, Marc P, "Randomized Trial of a Vascular Care Team vs Education for Patients With Peripheral Artery Disease." (2024). Heart and Vascular Articles. 61.
https://scholarlyworks.ohiohealth.com/heart-vascular-articles/61