Lower extremity peripheral arterial disease (PAD) affects nearly 25 percent of patients age 55 and older in primary care medical practices. Over five year follow up, 20 percent -30 percent of these men and women with PAD will have a myocardial infarction or stroke and an additional 25 percent will die, primarily from heart disease or stroke. Furthermore, 50 percent to 75 percent of PAD patients are diagnosed with PAD before they have clinical manifestations of coronary artery disease or cerebrovascular disease. Intensive coronary heart disease (CHD) risk factor interventions for PAD patients are recommended by the American Heart Association and the National Cholesterol Education Program. Yet pilot data collected for this study suggest that CHD risk factors are significantly less likely to be treated among PAD patients than among patients with coronary artery disease (CAD). Undertreatment of CHD risk factors in PAD likely contributes to high rates of cardiovascular morbidity and mortality as well as substantial medical care costs. The primary aim of this study is to document physician-reported behavior across the United States regarding CHD risk factor interventions in PAD. To achieve our aims we will survey 1,500 randomly identified general internists, cardiologists, family physicians, and vascular surgeons from across the United States. A factorial survey design will be used in which physicians will be randomized to receive one of three surveys assessing their CHD risk factor intervention behavior for a) a PAD patient without a history of heart disease or stroke; b) a CAD patient with no PAD; or c) a patient with no clinically manifest atherosclerosis. We hypothesize that physicians intervene less intensively upon CHD risk factors for PAD patients than for CAD patients but more intensively for PAD patients than for patients without documented atherosclerosis. The previously validated Theory of Planned Behavior suggests that physician behavior is determined by physician knowledge and attitudes, perceived behavioral control, and social norms, above and beyond the predictive value of prior behavior. The secondary aims of this study will identify whether physicians' knowledge and attitudes, perceived behavioral control, and social norms are most predictive of CHD risk factor intervention rates in PAD. By demonstrating the predictive relationship among these variables, our results will provide direction for future research aimed at improving physicians' prevention behavior for PAD patients. We know of no studies, other than pilot data collected for this proposal, documenting rates of CHD risk factor interventions for PAD patients in the United States. Previous study among CAD patients shows that once deficiencies are identified, CHD risk factor intervention rates can be successfully increased using targeted interventions. Our findings will be used to develop a subsequent targeted intervention, in a later study, aimed to eliminate barriers to CHD risk factor therapy in PAD. In this way, our results are expected to ultimately prevent cardiovascular morbidity and mortality among men and women with PAD.
| McDermott, Mary McGrae; Mandapat, Aimee Luna; Moates, Amanda et al. (2003) Knowledge and attitudes regarding cardiovascular disease risk and prevention in patients with coronary or peripheral arterial disease. Arch Intern Med 163:2157-62 |
| McDermott, Mary McGrae; Hahn, Elizabeth A; Greenland, Philip et al. (2002) Atherosclerotic risk factor reduction in peripheral arterial diseasea: results of a national physician survey. J Gen Intern Med 17:895-904 |
