LHSC Vascular Risk Management Program: The Multi-disciplinary Approach

K Lawlor, G Dresser, M Lovell, T Forbes
Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario

The Vascular Risk Reduction Clinic was established at the London Health Sciences Centre (LHSC) in October 2005 utilizing the Chronic Care Model in a multi-disciplinary setting/approach.  The goal of this program is to care for medically high-risk vascular patients by optimally  managing cardiovascular risk factors, thereby improving quality of life and reducing morbidity and mortality associated with vascular disease. 

Results: To date, 60 patients (36 males and 24 females) have entered this program and are followed every three to six months by the vascular surgeon, medical internist, nurse and dietitian.
The complete data set contains 37 patients who have had two or more follow up visits. Improvement in LDL-cholesterol (2.7 to 2.1 mmol/L; p=0.0159), total/HDL cholesterol ratio(4.3 to 3.5; p=0.011), systolic/diastolic BP (141 to 135/79 to 76 mm Hg; p= 0.0045 ) and hemoglobin A1c (7.4 to 6.4%; p= 0.0002).  As well, the overall 10 year risk assessment improved in all patients (Mean ATP III aged adjusted relative risk difference is 7.48, P=0.02).  Despite access to a dietician and motivational interviewing, smoking and body mass index were not reduced.

Conclusions: This preliminary data confirms the early success of this management model in this patient population.  Interventions based primarily on drug therapy (cholesterol, blood pressure, and blood sugar control) were more likely to achieve targets than those dependant on lifestyle modification (smoking and BMI.)  This data emphasizes the need for enhanced effort in smoking cessation and weight control.  We look forward to longer term follow-up to evaluate cardiovascular and cerebrovascular outcomes in this extremely high risk group of patients.