Proper Dosing of Anticoagulants in CAD/PAD - Episode 13

The Effect of CAD/PAD on Patient Quality of Life

April 21, 2020

Peripheral artery disease (PAD) and coronary artery disease (CAD) are similar conditions caused by atherosclerosis, in which the arteries in critical regions of the body narrow and are blocked. In a Pharmacy Times Insights video series, 2 experts discussed the importance of CAD/PAD management, education, and best practices.

The discussion included Paul P. Dobesh, PharmD, FCCP, BCPS, professor in the Department of Pharmacy Practice and Science University of Nebraska Medical Center’s College of Pharmacy, and James B. Groce, PharmD, CACP, a professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences.

In the discussion, Groce and Dobesh discussed which patients have an increased risk of CAD or PAD and how to maximize therapy.

“I think another thing is to make sure we’re optimizing therapy. When we talk about these patients who have symptoms and they’ve got chest pain episodes or they’ve got leg pain episodes—I always tell my students this, as well—asking the patient ‘Do you have pain?’ is not enough, because they may say no. But the reason they’re not having pain is because they’re not doing anything,” Dobesh said.

Dobesh added that the fear of exacerbating their condition can also affect quality of life within this patient population.

“They’ve stopped the evening walks with their spouse that they used to love to go on, they gave up on the garden that they wanted to have in retirement, they don’t get on the floor and roll around with the grandkids because they’re scared. So: ‘Are you having pain, and are you doing the things you want to be able to do?’ Are we optimizing a patient’s medical therapy to let them live a full life? I think those are things that we should make sure that, as clinicians, we focus on,” Dobesh added.

Groce and Dobesh also discussed primary and secondary prevention, along with the challenges of each.

“Primary prevention is hard. It really is kind of preventing disease from ever happening in the first place, which is what we’d love to do. Really, what it comes down to is identifying those patients, like you said, who are at risk. If we remember that this is atherosclerotic disease, then what are the risk factors for atherosclerosis? Many of us are familiar with these, right? It’s the smoking, it’s diabetes, it’s dyslipidemia and hypertension, those things that we can modify,” Dobesh said.

According to Dobesh, it’s all about decreasing risk. For example, if someone smokes, the goal is to get them to stop smoking. Secondary prevention is a little more straight forward, he noted, as the patient already has had a coronary event.

“In a patient who has had a coronary event, if a patient has an acute coronary syndrome, it’s a little different. After an acute coronary syndrome, dual antiplatelet therapy is a grade 1A recommendation. It’s the highest thing we should do. It’s nonnegotiable; we should be doing that for a year,” Dobesh said.

Additionally, the incorporation of new data into treatment has been slow.

“It’s frequently stated that, on average, not just specific to this particular clinical trial or even the use of beta-blockers, but on average—the statistic I’m about to reveal is shameful, I believe—but it takes about 17 years, on average, for things to really come, for research evidence to be implemented into clinical practice” Groce said.

As a result of these challenges in treating patients with CAD/PAD, Groce said clinicians must stay-up-to date on the latest information and treatment advances to use within their practice.

“I think there are some ways in which we really need to ready ourselves to act upon. One, be familiar with the clinical trial and what it may mean for our patients,” Groce said. “Today, it’s just not enough to pursue knowledge, but in our pursuit of knowledge, we really have to absorb it, think about it, communicate it with each other. What we’re doing here today, I hope, translate that into, again, what it might mean for patients who we see within our practice, and then, most importantly, it has to be implemented.”

Click here to view the full Pharmacy Times Insights video series, The Future of CAD/PAD Management.