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Medical management of vascular conditions gaining prominence in the new year

January 5, 2017

    Vascular care has been traditionally designed around the procedure, often at the expense of preventative and rehabilitative care strategies.

    While this has also been the case in cardiac care, the disparity is particularly pronounced in vascular services, where ambiguous data concerning the efficacy of medical management, coupled with limited financial incentives for prevention or rehabilitation, has often limited emphasis to procedural options. But this is slowly changing.

    New joint guidelines released

    In November 2016, the American Heart Association and American College of Cardiology released new joint guidelines for the treatment of Peripheral Artery Disease (PAD). Compared to the previous 2011 guidelines, these place greater emphasis on medical management as a key to treatment success.

    Notably, the 2016 guidelines recommend a supervised and structured exercise regimen for PAD patients in a hospital or outpatient facility. Patients should exercise for a minimum of 30-45 minutes per session, at least 3 times per week for a minimum of 12 weeks. Another notable change from the previous guidelines is new advice that PAD patients avoid exposure to second-hand smoke, expanding the scope of advice away from simple smoking cessation. Finally, the guidelines now recommend that patients receive an annual flu shot to avoid CV complications associated with flu infection.

    The changes included in the 2016 guidelines reflect an emerging consensus that secondary prevention strategies can reduce the risk of serious vascular complications leading to amputation.

    Vascular medicine registry announced

    Shortly following the publication of the joint AHA-ACC guidelines, the Society of Vascular Surgery and Society of Vascular Medicine also announced the creation of a new vascular medicine registry.

    The first of its kind, this registry will study the outcomes of medical management— as opposed to surgical or endovascular interventions— for PAD, carotid artery stenosis, and abdominal aortic aneurysm. The registry will work to identify optimal medication and dosages, evaluate methods for secondary prevention, and assess the need for subsequent interventions.

    These two advancements reflect a growing recognition of the benefits of medical management of vascular patients as part of an effective cross-continuum care strategy. Although vascular interventions will likely become a more important part of CV services across the next decade due to rising demand within an aging patient population, medical management of vascular conditions may slow or prevent the progression of PAD to the stage where a surgical or endovascular procedure is required, and therefore present significant benefits for programs pursuing value-based care goals.

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