Second best medical therapy.

Background: Best medical therapy (BMT) provides patients with peripheral arterial disease (PAD) substantial protection against future vascular events.

Objective: To determine the quality of BMT received by PAD patients in this vascular surgery unit.

Methods: Retrospective case-note review of 50 consecutive patients in each of the following groups: intermittent claudication (out-patients), symptomatic carotid artery disease (out-patients), lower limb angioplasty, lower limb bypass surgery, carotid endarterectomy.

Results: Overall BMT use was poor. Fifteen percent of smokers had assistance with smoking cessation noted. Seventy-eight percent of patients were taking an antiplatelet agent, 38% cholesterol-lowering medication and 51% antihypertensive medication. Fifty-three percent of patients had a cholesterol measurement, 50% of out-patients had a blood pressure measurement and 53% of non-diabetics had a random blood glucose performed. Sixteen of the patients with lower limb disease were given advice about exercise. Patients with a history of coronary artery disease were more likely to be taking cholesterol lowering, or antihypertensive medication.

Conclusions: BMT is poorly used in patients with PAD, which will result in an excess of cardiovascular morbidity and mortality. Strategies need to be developed to increase the use of BMT in our patients.