(P-117) A Rapid Review on the Adherence to Evidence-based Medical Therapy in Peripheral Artery Disease Patients

Background: Peripheral artery disease (PAD) is characterized by atherosclerotic occlusion of arteries in the lower extremities and is associated with increased cardiovascular morbidity and mortality. PAD treatment guidelines recommend the use of statins and antiplatelets in all PAD patients to reduce adverse cardiovascular and limb-related outcomes. In addition, hypertension and diabetes should be treated to reach recommended targets.

Objectives: The aim of this rapid review was to evaluate the level of adherence to evidence-based medical therapy (EBMT) recommended by PAD treatment guidelines in the real-world setting.

Methods: We searched PubMed and Embase using keywords, MeSH and Emtree terms related to the population, exposure and outcomes from their inception to 22 Sep 2020. We included randomized controlled trials, non-randomized studies, and observational studies reporting adherence to at least 1 of these 4 drug classes: 1) Statins, 2) antiplatelets, 3) anti-hypertensives and 4) anti-diabetic drugs. Non-English articles, abstracts, dissertations, animal studies and case reports or series, were excluded. A narrative summary of the results was performed.

Results: The search strategy yielded a total of 1843 articles and 42 articles were finally included. Most of the studies originated from US or Europe, with only 1 from Asia. Of the 42 included studies, 41, 31, 25 and 8 studies reported adherence on lipid lowering drugs, antiplatelets, anti-hypertensives and anti-diabetic drugs, respectively. There was substantial variability in the level of adherence to all 4 classes of drugs. The adherence to lipid lowering drugs/statins ranged from 23.5 to 92.0% and antiplatelets from 27.5 to 96.3%. Only 7 and 5 studies reported use of ‘any anti-hypertensive’ and ‘any anti-diabetic’ medications, respectively, and the proportion of the cohort treated were generally close to the proportion with hypertension and/or diabetes. When grouped by publication year, there was a trend of increasing adherence with newer studies. Adherence in studies published in 2016 – 2020 ranged from 52.4 – 89.6% for lipid lowering drugs and 66.2 to 96.3% for antiplatelets.

Conclusions: EBMT adherence in PAD patients was highly variable and a substantial proportion in many settings were undertreated. There was also a notable lack of Asian studies pertaining to EBMT adherence.