Vascular Medicine最新文献

{"title":"Association between guideline-directed medical therapy and reintervention risk following peripheral vascular interventions in patients with peripheral artery disease.","authors":"Santiago Callegari, Gaëlle Romain, Isabella Capuano, Jacob Cleman, Lindsey Scierka, Kim G Smolderen, Carlos Mena-Hurtado","doi":"10.1177/1358863X251320347","DOIUrl":"10.1177/1358863X251320347","url":null,"abstract":"<p><strong>Introduction: </strong>Reintervention following peripheral vascular intervention (PVI) for peripheral artery disease (PAD) is common. Guideline-directed medical therapy (GDMT) is recommended post-PVI, yet its association with reintervention outcomes remains unclear.</p><p><strong>Methods: </strong>We analyzed Vascular Quality Initiative registry data linked with Medicare outcome for patients undergoing PVI for PAD (2017-2018). GDMT was defined as the receipt of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker (ACE/ARB) therapy if hypertensive at discharge. Competing risk analyses and conditional risk models assessed the reintervention outcome, and the recurrent reintervention outcomes within 2 years, by GDMT receipt, compliance with each GDMT element, the number of elements received, and GDMT rate across sites and operators in a 1:1 propensity score-matched cohort.</p><p><strong>Results: </strong>We included 13,244 patients (mean age 72.0 ± 9.9, women 41.0%). The reintervention outcome did not differ by GDMT receipt (cumulative incidence: 43.0% [95% CI 41.0-44.9%] in no GDMT vs 41.2% [95% CI 39.4- 43.0%] in GDMT; subhazard ratio (sHR): 1.03 [95% CI 0.97-1.10]), compliance with GDMT elements, the number of elements received, or site and operator GDMT rates (sHR per 10% increase: 1.00 [95% CI 0.98-1.03] and 1.00 [95% CI 0.98-1.02]) (all <i>p</i> > 0.05). However, a higher operator GDMT rate reduced the recurrent reintervention risk (HR: 0.98 [95% CI 0.97-1.00], <i>p</i> = 0.026).</p><p><strong>Conclusion: </strong>Around 40% of patients undergoing a PVI experience reintervention within 2 years, but the outcome was not reduced with GDMT receipt, and higher GDMT rates by site and operators were not associated with reintervention risk. Future studies should focus on medication adherence, refills, and more granular GDMT data for PAD care surveillance postrevascularization.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"293-301"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early combination lipid-lowering therapy is associated with greater achievement of goal LDL-C: Insights from the OPTIMIZE PAD-1 trial.","authors":"Connie N Hess, Ashley Daffron, Mark R Nehler, Michael Szarek, Christopher P Cannon, Judith Hsia, Joseph J Saseen, Marc P Bonaca","doi":"10.1177/1358863X241309839","DOIUrl":"10.1177/1358863X241309839","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"321-323"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative experience implementing an emergency department-based outpatient low-risk pulmonary embolism management pathway.","authors":"S Nabeel Hyder, Valerie Gavrila, Anthony Cuttitta, Colin Greineder, Geoffrey D Barnes","doi":"10.1177/1358863X251326585","DOIUrl":"10.1177/1358863X251326585","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"326-329"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient knowledge and activation are key to improving outcomes in peripheral artery disease.","authors":"Mary O Whipple","doi":"10.1177/1358863X251334570","DOIUrl":"https://doi.org/10.1177/1358863X251334570","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":"30 3","pages":"281-282"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research priorities for peripheral artery disease: A statement from the Society for Vascular Medicine.","authors":"Mary M McDermott, Daniella Kadian-Dodov, Herbert A Aronow, Joshua A Beckman, Demetria M Bolden, Yulanka S Castro-Dominguez, Mark A Creager, Michael H Criqui, Philip P Goodney, Heather L Gornik, Naomi M Hamburg, Nicholas J Leeper, Jeffrey W Olin, Elsie Ross, Marc P Bonaca","doi":"10.1177/1358863X251330583","DOIUrl":"10.1177/1358863X251330583","url":null,"abstract":"<p><p>Lower-extremity peripheral artery disease (PAD) affects approximately 236 million people worldwide and at least eight million people in the United States (US). Despite availability of new therapies that prevent major adverse cardiovascular events (MACE), these and major adverse limb events (MALE) remain common and occur more frequently in people with PAD, either with or without coronary artery disease (CAD), compared to people with CAD who do not have PAD. The most effective therapies to prevent cardiovascular events are not identical in people with PAD and those with CAD. Walking impairment and the risk of lower-extremity amputation are significantly greater in people with PAD compared to those without PAD. This report from the Society for Vascular Medicine (SVM) proposes and summarizes high-priority topics for scientific investigation in PAD, with the goal of improving health outcomes in people with PAD. To develop this report, a multidisciplinary team of scientists and clinicians reviewed literature, proposed high-priority topics for scientific investigation, and voted to rank the highest priority topics for scientific investigation. Priorities for clinical scientific investigation include: determine the current prevalence of PAD in the US by age, sex, race, and ethnicity; improve methods to diagnose PAD; develop new medical therapies to eliminate walking impairment; and improve implementation of established therapies to reduce rates of MACE and MALE in people with PAD. Priorities in basic science and translational science investigation include: developing animal models that closely resemble the vascular, skeletal muscle, and platelet pathology in patients with PAD and defining the genetic and epigenetic contributors to PAD and PAD-associated outcomes. Successful investigation of these research priorities will require more well-trained investigators focused on scientific investigation of PAD, greater and more efficient enrollment of diverse patients with PAD in randomized clinical trials, and increased research funding dedicated to PAD.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"367-383"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease-specific knowledge among veterans with peripheral artery disease.","authors":"Olamide Alabi, Yakia Clark, Madhur Sancheti, Cori Grant, Aishat Mustapha, Rachel E Patzer, Tabia Henry Akintobi","doi":"10.1177/1358863X251333764","DOIUrl":"10.1177/1358863X251333764","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"309-311"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of tracking-based technology for patients with claudication.","authors":"Pavithira Sivagangan, Enrico Mancuso, Isabelle Sanders, Joseph Borucki, Philip W Stather","doi":"10.1177/1358863X251316198","DOIUrl":"10.1177/1358863X251316198","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral artery disease (PAD) typically presents with claudication. Although supervised exercise therapy is recommended, many hospitals do not have a program and therefore patients are unable to receive optimal therapy. Tracking-based technology (TBT), including activity monitors and mhealth applications, have stimulated the expansion into PAD management. This systematic review evaluates the effectiveness of TBT for claudication based on walking performance, perceived walking impairment, and quality of life (QoL).</p><p><strong>Methods: </strong>A multidatabase search was undertaken using the terms PAD OR intermittent claudication AND wearable devices OR mobile health applications. This systematic review was conducted according to PRISMA guidelines.ResultsA literature search identified 586 studies, of which 18 were eligible for inclusion. This totaled 1055 patients, with 15 randomized controlled trials and three cohort studies. Patients in the TBT group showed improvements in all walking ability parameters (including 6-minute walking distance, claudication onset time, maximum walking time, maximum walking distance, and claudication distance), QoL, and in the self-reported walking impairment questionnaires.</p><p><strong>Conclusion: </strong>There is evidence for supporting the introduction of TBT into the management of PAD as TBT improves walking performance, functional status, and QoL in patients with PAD. However, further information regarding adherence and compliance rates, as well as long-term outcomes, are imperative in assessing the effectiveness of TBT due to limited existing studies. <b>PROSPERO Registration No.: CRD42022307731</b>.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"353-363"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key findings from multisite implementation of electronic health record tools for clinical pretest probability of pulmonary embolism in the emergency department.","authors":"Damon E Houghton, Megan Keenan, Hayley Dykhoff, Kyle Campbell, Marie Hall, Heather Heaton, Kristine Thompson, Jamie Aranda, Sarah Balgord, Jonathan Rubin, Ali Raja, Sayon Dutta, Ryan Hanson, Dustin McEvoy, Wei He, Emily Cahill, Lisa Baumann Kreuziger, Rachel P Rosovsky","doi":"10.1177/1358863X251337456","DOIUrl":"10.1177/1358863X251337456","url":null,"abstract":"<p><strong>Background: </strong>The use of validated risk stratification tools for the workup of suspected pulmonary embolism (PE) is a recommendation of the American Society of Hematology and the American College of Emergency Physicians.</p><p><strong>Methods: </strong>We designed and implemented electronic clinical pretest probability (PTP) tools for use in emergency departments (ED). Overall, 38 EDs (tertiary and regional EDs) in the United States were involved across three health systems. PTP use was analyzed between September 12, 2022 and January 11, 2023 in 270,247 ED visits. PTP use was examined in terms of the percentage of visits for which patients underwent computed tomography pulmonary angiography (CTPA). Each site chose the 3-tier Wells' score for implementation and Site 2 designed a combined Wells', pulmonary embolism rule-out criteria (PERC), and YEARS score.</p><p><strong>Results: </strong>At Site 3, forced use resulted in documented PTP scores in 49-53% of ordered CTPAs. At Sites 1 and 2, where PTP scores were optional, documented PTP scores occurred in 2-3% and 1-3% of CTPA orders, respectively. At Site 1, the use of PTP increased slightly over the study period, with signs that PE yield on imaging was also increasing (3.4-5.9%). At Site 2, PE yield on imaging was 9-10%, and it remained similar, with similar use of PTP tools over the study period. PE yield (6-8%) on imaging also remained similar throughout the study at Site 3.</p><p><strong>Conclusions: </strong>Guideline-endorsed PTP scores for PE at three independent health systems in the United States did not increase PE yield on imaging. Novel implementation strategies involving interdisciplinary teams are urgently needed.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":"30 3","pages":"302-308"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription of aspirin plus low-dose rivaroxaban in patients with peripheral artery disease after lower-extremity revascularization.","authors":"Mario Enrico Canonico, Connie N Hess, Sivan Naveh, R Kevin Rogers, Mark R Nehler, Shea E Hogan, Judith A Hsia, Scott D Berkowitz, Marc P Bonaca","doi":"10.1177/1358863X251331561","DOIUrl":"10.1177/1358863X251331561","url":null,"abstract":"","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"318-320"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient factors associated with activation level in peripheral artery disease.","authors":"Margaret A Reilly, Megan E Alagna, Cassandra Iroz, Emily Ho, Alexander Lundberg, Andrew W Hoel, Ashley K Vavra, Julie K Johnson, Karen J Ho","doi":"10.1177/1358863X251318652","DOIUrl":"10.1177/1358863X251318652","url":null,"abstract":"<p><strong>Introduction: </strong>As a chronic and incurable condition, lower extremity peripheral artery disease (PAD) and its optimal self-management requires patient participation in treatment. Patient activation (knowledge, skills, and confidence to manage one's health) is known to improve chronic disease outcomes. We aimed to identify factors associated with activation in patients with PAD.</p><p><strong>Methods: </strong>In this single-center study, participants with PAD completed a survey assessing demographics, activation, PAD knowledge, and functional health literacy (FHL). The primary outcome, activation, was measured by the Patient Activation Measure (PAM-13). The PAD knowledge score was the percentage of correct responses, and FHL was assessed using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Bivariable analysis and logistic regression identified factors associated with activation.</p><p><strong>Results: </strong>Of the 91 participants (49.5% women, mean ± SD age: 68.6 ± 11.9 years, 29.7% Black), 72.6% were activated, 78.7% demonstrated adequate FHL, and the mean knowledge score ± SD was 79.1% ± 13.3%. White race (<i>p</i> = 0.025), higher income (<i>p</i> = 0.015), ability to ambulate (<i>p</i> = 0.023), and increased knowledge score (<i>p</i> = 0.002) were associated with activation in bivariable analyses. In a logistic regression model, younger age (<i>p</i> = 0.029), higher income (<i>p</i> = 0.016), and higher knowledge score (<i>p</i> = 0.012) independently correlated with odds of greater activation.</p><p><strong>Conclusions: </strong>Many participants were activated, demonstrated adequate FHL, and scored well on the PAD knowledge test. The remaining 27.5% were inactivated, which was associated with poor PAD knowledge and certain demographic characteristics. Future studies should focus on developing and implementing patient-centric educational interventions for inactivated patients and strategies to increase activation.</p>","PeriodicalId":23604,"journal":{"name":"Vascular Medicine","volume":" ","pages":"283-292"},"PeriodicalIF":3.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}