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Vascular Medicine Specialty Updates

August 2016

Study reveals high cost of tobacco use in PAD

A new population health study underscores the clinical and financial impact of tobacco use on patients with peripheral artery disease (PAD). Of the 22,203 patients with PAD tracked in the study, nearly half of the tobacco users were hospitalized over the course of a year, a rate 35% higher than that of nonsmokers with PAD (p<0.001). Individuals with PAD who smoked were admitted for peripheral or visceral atherosclerotic diseases, acute myocardial infarction, and other coronary and stroke ischemic events (p<0.05). Healthcare utilization costs were $64,041 a year for tobacco users and $45,918 for nonusers, an $18,000 difference that contrasts with the estimated $500 cost of a fully supported tobacco-cessation intervention. Lead authors Sue Duval, PhD, and Alan T. Hirsch, MD, of the University of Minnesota suggest that quality vascular care may be best defined by the consistent provision of tobacco cessation programs to all PAD patients who smoke. The paper appears in the Oct. 2016 issue of Journal of the American College of Cardiology.

Exercise shown to be equal or superior to stenting

Supervised exercise, when compared to placing stents, produces comparable or superior improvements in functional status and quality of life for patients with aorto-iliac peripheral artery disease and severe claudication, a national study reports. In the National Institutes of Health-sponsored multicenter trial (CLEVER), researchers sought to define the relative roles of supervised exercise, primary stent placement, or claudication pharmacotherapy in treatment. All patients received optimal medical care (risk-reduction pharmacotherapy, cilostazol, and a home walking program) and were followed for 18 months after randomization, with both treadmill and quality-of-life outcome measurements completed for all patients. Supervised exercise as a primary claudication treatment was found more effective than either other treatment at improving functional status at 6 months, and this outcome was durable for 18 months. The study was led by M Health physician Alan T. Hirsch, MD, with Tim Murphy, MD, of Brown University, and colleagues. Findings appear in the March 2015 Journal of the American College of Cardiology.

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— Alan Hirsch, MD

Vascular medicine specialist named to Best Doctors list

Alan T. Hirsch, MD, FACC, FAHA, MSVM, director and founder of the University of Minnesota Health Heart Care Vascular Medicine program, has been recognized in 2015-2016 Best Doctors in America. An online resource developed by Best Doctors, Inc., the list identifies leading physicians and is generated through an independent poll of more than 40,000 physicians in 40 specialties and 400 subspecialties. For more information, visit bestdoctors.com. Hirsch was also previously named a 2015 Top Doctor by Mpls.-St. Paul Magazine.

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Vascular Medicine: Holistic Vascular Disease Diagnosis and Treatment

A preventive, long-term approach creates cost-effective, quality outcomes and helps patients better manage the risks of peripheral arterial disease and other vascular conditions.

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August 2016

Integrated Care Produces Successful Outcome in Patient with PAD

Patient with severe claudication joins a supervised exercise and wellness program. After 3 months, he doubled the distance he could walk pain free.

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