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Peripheral Arterial Disease in Saudi Arabia :

Where Do We Stand?. Peripheral Arterial Disease in Saudi Arabia :. Mohammed Al- Omran , MD, MSc, FRCSC Associate Professor & Vascular Surgeon, King Saud University Scientist, LKSKI- St’ Michael’s Hospital, University of Toronto. 100. 80. Controls. 60. Survival (%). 40. IC. 20. CLI.

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Peripheral Arterial Disease in Saudi Arabia :

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  1. Where Do We Stand? Peripheral Arterial Disease in Saudi Arabia : Mohammed Al-Omran, MD, MSc, FRCSC Associate Professor & Vascular Surgeon, King Saud University Scientist, LKSKI- St’ Michael’s Hospital, University of Toronto

  2. 100 80 Controls 60 Survival (%) 40 IC 20 CLI 0 0 5 10 15 Follow-up (years) Why it is important to recognize patients with PAD? • Life expectancy reduced by • 10 years in patients with PAD • Mortality rate • ~ 25% at 5 years • ~ 50% at 10 years • ~ 75% at 15 years CLI=critical limb ischemia. IC=intermittent claudication. Norgren L et al. Eur J Vasc Endovasc Surg. 2007;33(suppl 1):S1-S75.

  3. Why it is important to recognize patients with PAD? PAD places individuals at high short and long term risk of MI, Stroke & Death

  4. Management of PAD

  5. What are the Goals of treating patients with PAD? Relief symptoms Improve quality of life Limb salvage Prolong survival

  6. Strategies in treating patients with PAD Improve Lower Limb Circulation Risk Factors Modification

  7. Strategies in treating patients with PAD • Risk Factors Modification • Diet and weight control • Exercise • Antiplatlets • Hypertension control • Diabetes control • Lipid control • Smoking Cessation

  8. Strategies in treating patients with PAD • Improve Lower Limb Circulation • Conservative (Exercise Program) • Intervention ( Revascularization) • - Angioplasty +/- Stenting • - Surgical Bypass

  9. Summary of the Evidence

  10. Summary of the Evidence

  11. Where Do We Stand in Saudi Arabia? What Should We Know?

  12. What Should we Know? Is PAD a public health issue? Health Care Provider: Is there a knowledge gap? Is there an action gap? Is there a care gap? Is there a missed opportunity in using PAD (ABI) as a predictor in order to prevent the adverse cardiovascular outcomes? Population: Is there a public awareness about PAD?

  13. What Do We Know?

  14. Is PAD a Public Health Issue ?

  15. - 471 patients - Mean age 57 - Male 68% Prevalence - 11.7 % (95% CI 8.9% to 14.9%) - 92.7% were asymptomatic Prevalence of and Risk Factors for Peripheral Arterial Disease in Saudi Arabia: A Pilot Cross-sectional Study Alshaekh et al. SMJ. 2007;28:412-414

  16. Prevalence of PAD US Data European Data Saudi Data Diehm2 Age ≥65 PARTNERS5 Age >70, or between 50–69 with history of diabetes or smoking San Diego4 Mean Age=66 NHANES3 Age ≥70 NHANES3 Age >40 Rotterdam1 Age >55 Pilot Study6 Age >45 • Prevalence was estimated using different methods • Meijer WT et al. Arterioscler Thromb Vasc Biol. 1998;18:185-192. • Diehm C et al. Atherosclerosis. 2004;172:95-105. • 3. Selvin E et al. NHANES. Circulation. 2004;110:738-743. • 4. Criqui MH et al. Circulation. 1985;71:510-515. • 5. Hirsch AT et al. JAMA. 2001;286:1317-1324. 6. Alshaekh et al. SMJ. 2007;28:412-414

  17. Is there a knowledge and action gaps in managing patients with PAD?

  18. 897 physicians (Internists/ GPs/ Cardiologists/ Vascular Surgeons) • Response rate 59 % (529 physicians) Atherosclerotic Risk Reduction Therapy in Peripheral Arterial Disease Compared to Coronary Artery Disease: Perception and Knowledge of Physicians in Saudi Arabia Al-Omran et al. In press

  19. Knowledge of the current recommended target of:

  20. Attitude towards routine evaluation of risk factors:

  21. Attitude towards routine patients counseling with regards to the importance of:

  22. Attitude towards routine initiating/modifying risk reduction pharmacotherapy:

  23. Conclusion Despite a considerable effort to evaluate and counsel patients for their atherosclerotic risk factors The perception towards risk reduction in PAD/CAD identify glaring knowledge and action gaps

  24. Is there a care gap in managing patients with PAD?

  25. - 140 consecutive symptomatic PAD patients presented to KKUH over 1 year (Jan 2006 – Dec 2006) Risk Reduction Status in Patients with Peripheral Arterial Disease Presenting to a Major Teaching Hospital -Mean age 62

  26. Risk Reduction Status in Patients with Peripheral Arterial Disease Presenting to a Major Teaching Hospital

  27. How about the rest of the World?

  28. Conclusion The control of risk factors in patients with PAD is suboptimal

  29. Is there a missed opportunity in using PAD (ABI) as a predictor in order to prevent the adverse cardiovascular outcomes?

  30. Peripheral Arterial Disease in SPACE registry: A Preliminary Analysis Objectives To identify the prevalence of PAD in patients presenting with acute coronary events To identify the prevalence of PAD in patients presenting with acute coronary events and do not have history of CAD (missed opportunity)

  31. Peripheral Arterial Disease in SPACE registry: - 545 patients with PAD (2479 ACS patients) - Mean age 63 - Male 72% Prevalence of PAD22 % Prevalence of PAD in patient with no history of CAD 38%

  32. Risk Reduction Pharmacotherapy in patients with PAD (SPACE registry):

  33. Conclusion There is a great opportunity in preventing acute coronary events that we are missing We can simply utilize this opportunity by recognizing patients with PAD (symptomatic or asymptomatic) and aggressively control their risk factors

  34. Is there a public awareness about PAD?

  35. Is there a public awareness about PAD? • A cross-sectional interview-based survey during a 4 day campaign that was organized at KKUH outpatient clinics and 3 shopping centers in Riyadh, Saudi Arabia. - Sample Size: 866 out of 923 , Response (93.8%)

  36. Is there a public awareness about PAD?

  37. Is there a public awareness about PAD?

  38. Is there a public awareness about PAD?

  39. Conclusion The awareness of public towards PAD is suboptimal

  40. So, Let’s wrap-up

  41. What Should we Know? Is PAD a public health issue? Health Care Provider: Is there a knowledge gap? Is there an action gap? Is there a care gap? Is there a missed opportunity in using PAD (ABI) as a predictor in order to prevent the adverse cardiovascular outcomes? Population: Is there a public awareness about PAD?

  42. - Increase public and Physicians awareness - Disseminating the guidelines - PAD registry and Practice auditing Future Direction

  43. Task Force - Physicians awareness Outreach CME program

  44. Task Force - Public awareness Campaigns in shopping centres

  45. Task Force • PAD registry and Practice auditing • King Khalid University Hospital

  46. Conclusions A call to action to implement effective strategies to diagnose and mange patients with PAD, to encourage health professionals to use risk reduction therapy and to increase the public awareness are needed Different strategies can help which are very much at the beginning and have a long way to develop

  47. “The journey of a thousand miles begins with one step”

  48. Thank You www.vascular–ksu.com

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