Background

Peripheral arterial disease (PAD) is one of the most common diseases worldwide and affected patients have an increased risk for cardiovascular events. The main goals of PAD treatment include modification of risk factors and prevention of cardiovascular events by means of guideline-recommended and specialized ambulatory care. Knowledge on treatment regimens and outpatient care structures in different German states is essential to improve the overall quality of medical care as well as patient outcome. 

Aim

The aim of this study was to analyze the care of PAD patients with emphasis on pharmacotherapy and outpatient treatment patterns with special focus on regional differences in Germany. 

Methods

This study included data of 17.633.970 patients collected in Germany between 2009 and 2018. This data was provided by analyzing all statutory health insured patients with PAD in Germany. Ambulatory care structure included treatments by vascular surgeons, angiologists, cardiologist, internal medicine physician and primary care physicians. Furthermore, prescription of guideline-recommended pharmacotherapy (statins and antiplatelets) was analyzed for the period of 2012–2016. For our analysis we used chi-squared test and two-way Anova.

Results

Nationwide, prescription frequency of statins increased from 40% in 2009 to 50%(p<0,0001) in 2016. Similar results were seen in the prescription frequency of antiplatelet agents, which increased from 26 % in 2009 to 30 % (p<0,0001) in 2016. In fact, prescription frequency of both statins and antiplatelet drugs remained insufficient in every federal state (p>0,05), despite wide access to general practitioners. Nevertheless, there is a significant difference between rural and urban regions (Bavaria 46% vs. North Rhine-Westphalia 44%, p<0,05). However, in every federal state, treatment by the vascular specialist is low. In 2018 only 10% of patients were treated by vascular surgeons and 9% by angiologists. 

Conclusion

Our study shows that, for PAD patients, outpatient care as well as prescription frequency of guideline-based therapy is insufficient in every federal German state. According to our data, there is a need to establish regional structures for PAD patients that can improve current care and ultimately reduce mortality in this high-risk population.