{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:14:23Z","timestamp":1740147263430,"version":"3.37.3"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012921","name":"Royal College of Surgeons in Ireland","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012921","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ir J Med Sci"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Symptomatic peripheral arterial disease (PAD) is a common cause for referral from primary care to vascular surgery. Best medical therapy (BMT), encompassing anti-platelets, statins, smoking cessation, blood pressure and glycaemic control, is a cornerstone of PAD management. However, these easily modifiable risk factors are often left unaddressed between referral and clinic review.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective audit of electronic \u2018Healthlink\u2019 referrals by GPs to the vascular department for symptomatic PAD between July 2021 and June 2022 was performed. Referrals were individually reviewed for demographics, symptoms, medical history, smoking status and medications. An information leaflet on BMT was posted to all GP practices in the Soalta region as part of an educational intervention, with plans to re-audit after 6\u00a0months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One-hundred-and-seventy referrals were analysed. The median age was 68.5\u00a0years (range 33\u201394) and 69% (<jats:italic>n<\/jats:italic>\u2009=\u2009117) were male. The typical vasculopath comorbidity profile was noted. Fifty-two percent (<jats:italic>n<\/jats:italic>\u2009=\u200988) were referred with claudication-type pain and 25% (<jats:italic>n<\/jats:italic>\u2009=\u200943) with critical limb ischaemia (CLI). Twenty-eight percent (<jats:italic>n<\/jats:italic>\u2009=\u200933) were active smokers and 31% (<jats:italic>n<\/jats:italic>\u2009=\u200936) had no smoking status documented. Regarding BMT, only 34.5% (<jats:italic>n<\/jats:italic>\u2009=\u200940) and 52% (<jats:italic>n<\/jats:italic>\u2009=\u200960) were on anti-platelets and statins, respectively. Suspected CLI was not significantly associated with BMT prescription at referral (<jats:italic>p<\/jats:italic>\u2009=\u20090.664). Only eleven referral letters mentioned risk factor optimisation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our first-cycle results identified significant scope for improvement in community-based risk factor modification for PAD referrals. We aim to continue supporting and educating our colleagues that effective medical management can start safely in primary care and further explore the barriers preventing this.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11845-023-03362-1","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T15:02:52Z","timestamp":1682521372000},"page":"3007-3010","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An audit of secondary prevention for peripheral arterial disease in primary care \u2014 scope for improved collaboration between vascular surgery and general practitioners"],"prefix":"10.1007","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7731-3182","authenticated-orcid":false,"given":"Megan Power","family":"Foley","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Tubassam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-9541","authenticated-orcid":false,"given":"Stewart R.","family":"Walsh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"issue":"12","key":"3362_CR1","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1161\/CIRCRESAHA.121.318535","volume":"128","author":"AW Aday","year":"2021","unstructured":"Aday AW, Matsushita K (2021) Epidemiology of peripheral artery disease and polyvascular disease. Circ Res 128(12):1818\u20131832","journal-title":"Circ Res"},{"key":"3362_CR2","doi-asserted-by":"crossref","unstructured":"Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF (1997) Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation 96(1):44\u20139","DOI":"10.1161\/01.CIR.96.1.44"},{"key":"3362_CR3","doi-asserted-by":"crossref","unstructured":"Society for Vascular Surgery Lower Extremity Guidelines Writing G, Conte MS, Pomposelli FB et al (2015) Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 61(3 Suppl):2S-41S","DOI":"10.1016\/j.jvs.2014.12.009"},{"issue":"3","key":"3362_CR4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.ejvs.2017.07.018","volume":"55","author":"V Aboyans","year":"2018","unstructured":"Aboyans V, Ricco JB, Bartelink MEL et al (2018) Editor\u2019s Choice - 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55(3):305\u2013368","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"12","key":"3362_CR5","first-page":"e686","volume":"135","author":"MD Gerhard-Herman","year":"2017","unstructured":"Gerhard-Herman MD, Gornik HL, Barrett C et al (2017) 2016 AHA\/ACC Guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135(12):e686\u2013e725","journal-title":"Circulation"},{"issue":"1","key":"3362_CR6","first-page":"33","volume":"80","author":"ME O'Donnell","year":"2011","unstructured":"O\u2019Donnell ME, Reid JA, Lau LL (2011) Optimal management of peripheral arterial disease for the non-specialist. Ulster Med J 80(1):33\u201341","journal-title":"Ulster Med J"},{"issue":"5","key":"3362_CR7","doi-asserted-by":"publisher","first-page":"239","DOI":"10.31128\/AJGP-11-19-5160","volume":"49","author":"SJ Aitken","year":"2020","unstructured":"Aitken SJ (2020) Peripheral artery disease in the lower limbs: \u201cthe importance of secondary risk prevention for improved long-term prognosis.\u201d Australian Journal of General Practice 49(5):239\u2013244","journal-title":"Australian Journal of General Practice"},{"issue":"3","key":"3362_CR8","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1308\/rcsann.2017.0204","volume":"100","author":"P Stather","year":"2018","unstructured":"Stather P, Muscara F (2018) Cardiovascular risk reduction in referrals to outpatient vascular clinics. Ann R Coll Surg Engl 100(3):194\u2013198","journal-title":"Ann R Coll Surg Engl"},{"issue":"3","key":"3362_CR9","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.ejvs.2015.10.022","volume":"51","author":"B Sigvant","year":"2016","unstructured":"Sigvant B, Lundin F, Wahlberg E (2016) The risk of disease progression in peripheral arterial disease is higher than expected: a meta-analysis of mortality and disease progression in peripheral arterial disease. Eur J Vasc Endovasc Surg 51(3):395\u2013403","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"3362_CR10","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.avsg.2020.10.004","volume":"72","author":"TI Kim","year":"2021","unstructured":"Kim TI, Kiwan G, Mohamedali A et al (2021) Multiple reinterventions for claudication are associated with progression to chronic limb-threatening ischemia. Ann Vasc Surg 72:166\u2013174","journal-title":"Ann Vasc Surg"},{"issue":"3","key":"3362_CR11","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.jvs.2021.02.045","volume":"74","author":"V Madabhushi","year":"2021","unstructured":"Madabhushi V, Davenport D, Jones S et al (2021) Revascularization of intermittent claudicants leads to more chronic limb-threatening ischemia and higher amputation rates. J Vasc Surg 74(3):771\u2013779","journal-title":"J Vasc Surg"},{"issue":"1","key":"3362_CR12","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.119.008450","volume":"13","author":"H Djerf","year":"2020","unstructured":"Djerf H, Millinger J, Falkenberg M et al (2020) Absence of long-term benefit of revascularization in patients with intermittent claudication: five-year results from the IRONIC randomized controlled trial. Circ Cardiovasc Interv 13(1):e008450","journal-title":"Circ Cardiovasc Interv"},{"issue":"8","key":"3362_CR13","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1001\/jamasurg.2016.0415","volume":"151","author":"MA Hussain","year":"2016","unstructured":"Hussain MA, Al-Omran M, Mamdani M et al (2016) Efficacy of a guideline-recommended risk-reduction program to improve cardiovascular and limb outcomes in patients with peripheral arterial disease. JAMA Surg 151(8):742\u2013750","journal-title":"JAMA Surg"},{"issue":"9","key":"3362_CR14","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1161\/CIRCULATIONAHA.120.047994","volume":"143","author":"M Sogaard","year":"2021","unstructured":"Sogaard M, Nielsen PB, Skjoth F et al (2021) Temporal changes in secondary prevention and cardiovascular outcomes after revascularization for peripheral arterial disease in Denmark: a nationwide cohort study. Circulation 143(9):907\u2013920","journal-title":"Circulation"},{"issue":"1","key":"3362_CR15","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1177\/0003319707303698","volume":"59","author":"SA Badger","year":"2008","unstructured":"Badger SA, Soong CV, Lee B et al (2008) Prescribing practice of general practitioners in Northern Ireland for peripheral arterial disease. Angiology 59(1):57\u201363","journal-title":"Angiology"},{"key":"3362_CR16","doi-asserted-by":"crossref","unstructured":"Hoeks SE, Scholte op Reimer WJ, van Gestel YR et al (2009) Medication underuse during long-term follow-up in patients with peripheral arterial disease. Circ Cardiovasc Qual Outcomes 2(4):338\u201343","DOI":"10.1161\/CIRCOUTCOMES.109.868505"},{"issue":"1231","key":"3362_CR17","first-page":"U1918","volume":"119","author":"N Kuiper","year":"2006","unstructured":"Kuiper N, Gordon M, Roake J, Lewis D (2006) Treating claudication in 5 words (stop smoking and keep walking) is no longer enough: an audit of risk factor management in patients prescribed exercise therapy in New Zealand. N Z Med J 119(1231):U1918","journal-title":"N Z Med J"},{"key":"3362_CR18","first-page":"1","volume":"100","author":"P Stather","year":"2017","unstructured":"Stather P, Muscara F, Benson RA et al (2017) Cardiovascular risk reduction in referrals to outpatient vascular clinics. The Annals of The Royal College of Surgeons of England 100:1\u20135","journal-title":"The Annals of The Royal College of Surgeons of England"},{"issue":"5","key":"3362_CR19","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.ejvs.2014.12.017","volume":"49","author":"CT Cronin","year":"2015","unstructured":"Cronin CT, McCartan DP, McMonagle M et al (2015) Peripheral artery disease: a marked lack of awareness in Ireland. Eur J Vasc Endovasc Surg 49(5):556\u2013562","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"3","key":"3362_CR20","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.surge.2021.03.009","volume":"20","author":"S Keelan","year":"2022","unstructured":"Keelan S, Foley N, Healy D et al (2022) Poor patient awareness of peripheral arterial disease, it is time to optimize the clinical visit. Surgeon 20(3):157\u2013163","journal-title":"Surgeon"},{"issue":"4","key":"3362_CR21","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s11845-009-0301-0","volume":"178","author":"EP O'Sullivan","year":"2009","unstructured":"O\u2019Sullivan EP, Bhargava A, O\u2019Callaghan M et al (2009) Awareness of diabetes complications in an Irish population. Ir J Med Sci 178(4):401\u2013406","journal-title":"Ir J Med Sci"}],"container-title":["Irish Journal of Medical Science (1971 -)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11845-023-03362-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11845-023-03362-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11845-023-03362-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T03:22:50Z","timestamp":1701487370000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11845-023-03362-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["3362"],"URL":"https:\/\/doi.org\/10.1007\/s11845-023-03362-1","relation":{},"ISSN":["0021-1265","1863-4362"],"issn-type":[{"type":"print","value":"0021-1265"},{"type":"electronic","value":"1863-4362"}],"subject":[],"published":{"date-parts":[[2023,4,26]]},"assertion":[{"value":"2 November 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This was an anonymised, retrospective audit with no direct impact on patient care, as such there was no requirement to obtain formal ethical approval.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}