Quality assessment and comparative analysis on the recommendations of current guidelines on the management of peripheral arterial disease: a systematic review protocol (original) (raw)
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Quality assessment of peripheral artery disease clinical guidelines
Journal of vascular surgery, 2016
Clinical practice guidelines (CPGs) provide recommendations to assist health professionals and patients in the process of making decisions for specific clinical conditions to improve the quality of the patient care. However, there are concerns about the quality of some CPGs. The aim of this study was to review the quality of CPGs in pharmacologic management of peripheral artery disease (PAD). A systematic review of CPGs for the pharmacologic treatment of PAD was performed. CPGs published between 2003 and January 2015 in English, Spanish, or French were retrieved using PubMed, Cochrane, and TRIP databases; guideline developer organization Web sites, and European and American scientific societies related to PAD Web sites. One reviewer performed the search and guideline selection, which was validated by a second reviewer. Three appraisers independently assessed the quality of CPGs using the Appraisal of Guidelines, REsearch and Evaluation II (AGREE II) instrument. A total of seven CPGs...
2022
IntroductionPeripheral Artery Disease (PAD) is a major atherosclerotic disease, and there are several clinical practice guidelines available for it. The paucity of strong evidence is known to give room for variations in recommendations across guidelines with attendant confusion amongst clinicians in clinical practice. This study aims to conduct a quality assessment and comparative analysis on PAD screening and diagnostic recommendations in the management of PAD.MethodsWe conducted a systematic review of CPGs’ written after 2010 and on or before 2020. An exhaustive search was conducted through the major medical databases and websites of specialist international organisations of interest and using our inclusion criteria, the appropriate guidelines were extracted. The AGREE-II instrument was used for quality assessment, while the recommendations across screening and diagnosis were extracted and then comparatively analysed.ResultsWe found nine guidelines that fit our criteria. The guide...
Evidence-Based Practice Guideline for Peripheral Artery Disease
2018
Evidence-Based Practice Guideline for Peripheral Artery Disease by Jenny Ann S. Managbanag MSN, Olivet Nazarene University, 2014 BSN, Silliman University, 1995 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2018 Abstract The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers’ theory of diffusion of innovations was used to facilitate the adoption of the guideline. This project helpe...
Guideline on peripheral arterial disease
Vasa
What is key and/or novel in these guidelines Area Recommendation Pages Chapter 2: Epidemiology c It is recommended that recognition be given that patients with PAD have a high risk of vascular events in other vascular beds. (Evidence Level A), and as such these patients should always be considered high risk for further events. (Level A, class I) 12 c In patients with PAD, it is recommended that optimization of treatment of the concomitant coronary artery disease and cardiac failure should be undertaken. (Evidence Level B, class I) 12 c It is recommended that in patients with renal failure, that attention be paid to the concomitant presence of arteriosclerosis (atherosclerosis plus calcification) in the lower limb, as such disease in this patient population has a poorer prognosis.
Journal of Public Health, 2010
Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.
Journal of Public Health, 2010
Peripheral arterial disease (PAD), a marker of elevated vascular risk, is highly prevalent in general practice. We aimed to investigate patient characteristics and outcomes of PAD patients treated according to the guidelines versus those who were not. Methods. PACE-PAD was a multicentre, cluster-randomised prospective, longitudinal cohort study of patients with PAD in primary care, who were followed-up for death or vascular events over 18 months. Guideline-orientation was assumed, if patients received anti¬coagu¬lant/antiplatelet therapy, exercise training, and (if applicable) advice for smoking cessation and therapy of diabetes mellitus, hypertension, or hypercholesterolemia, respectively. Results. The 5099 PAD patients (mean age 68.0 ± 9.0 years, 68.5% males) who were followed-up were in Fontaine stages I, IIa, IIb, III, and IV in 22.5%, 34.6%, 30.1%, 7.8%, and 3.5% (1.5% not specified). Comprehensive guideline orientation was reported in 28.4% only, however, patients in lower Fontaine stages received more often guideline-oriented therapy (I: 30.3%; IIa: 31.6%, IIb: 29.1%, III: 9.8%, IV: 18.0%). During 18 months, 457 patients died (224 due to cerebrovascular or coronary deaths), 319 had instable angina pectoris, 116 myocardial infarction, and 140 an ischemic stroke event. In total, 24% of patients had experienced any vascular event (19.1% a first event). Event rates did not differ between patients treated according to guidelines, and those who were not. Conclusion. The present PAD cohort was a high-risk sample with an unexpectedly high rate of deaths and vascular events. While physicians appear to focus on the treatment of individual risk factors, rates of comprehensive PAD management in line with guideline recommendations are still suboptimal. Factors contributing to the lacking difference between outcomes in the guideline-oriented and nonguideline-oriented groups may comprise low treatment intensity or other reasons for unsatisfactory effect of treatment, misclassification of events, patient's non-compliance with therapy.
European Journal of Vascular and Endovascular Surgery, 2010
Objectives: To briefly inform on the conclusions from a conference on the next 10 years in the management of peripheral artery disease (PAD). Design of the Conference: International participation, invited presentations and open discussion were based on the following issues: Why is PAD under-recognised? Health economic impact of PAD; funding of PAD research; changes of treatment options? Aspects on clinical trials and regulatory views; and the role of guidelines. Results and Conclusions: A relative lack of knowledge about cardiovascular risk and optimal management of PAD patients exists not only among the public, but also in parts of the health-care system. Specialists are required to act for improved information. More specific PAD research is needed for risk management and to apply the best possible evaluation of evidence for treatment strategies. Better strategies for funding are required based on, for example, public/private initiatives. The proportion of endovascular treatments is steadily increasing, more frequently based on observational studies than on randomised controlled trials. The role of guidelines is therefore important to guide the profession in the assessment of most relevant treatment.