Monday, March 20, 2006

Lessons from the REACH Registry

REACH is the acronym for " Reduction of Atherothrombosis for Continued Health ". This is a registry of 63,129 patients from 44 countries with 1 year follow up. REACH enrolled patients over 45 with documented CAD, CVD, or PAD or at least three risk factors for atherothrombosis.

The risk factors included advanced age, smoking, diabetes, hypercholesterolemia, diabetic nephropathy, low ankle-brachial index, or an asymptomatic >70% carotid stenosis. Following up these patients allow us to study the natural history of atherothrombosis. It is important to note that these patients are on standard, present day therapy.

This REACH registry teaches us a few important lessons. The most obvious is that registry teaches us what is happening to our patients despite good therapy. In other words, where we can improve to get even better outcomes. Zero morbidity or mortality is the best, but perhaps unachievable. Something nearer zero will be good.

The second lesson, of course, is that we should see patient not as CAD, or CVA or PVD but as diffuse atherothrombosis presenting focally at one point in time but with the potential to involve multisystems. As the table points out, patients with CAD only, for example, showed a 3% one-year rate of CV death, MI, or stroke, and at least one of those events occurred in about 6.4% in those with CAD and cerebrovascular disease (CVD) and in >7% of those with CAD, CVD, and peripheral arterial disease (PAD). Just to emphasize that every one of our CAD patients has a 3% chance of developing an MI, developing stroke or at worst developing a permanent condition known as death. And all this happening despite current day therapy. Now that must give us a wakeup call.

If not us, at least our "friendly health insurance" providers.

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