To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

TL;DR

This study compares long-term outcomes of peripheral artery disease patients treated with revascularization, home-based exercise, or standard care.

Contribution

Demonstrates that revascularization and structured exercise improve survival and reduce hospitalizations compared to standard care.

Findings

Mortality was significantly lower in revascularization and exercise groups compared to the control group.

All-cause hospitalization rates were much higher in the control group.

Peripheral revascularization rates were similar across all groups.

Abstract

Peripheral artery disease (PAD) is recognized as a
significant contributor to the public health burden in the cardiovascular field
and has a significant rate of morbidity and mortality. In the intermediate
stages, exercise therapy is recommended by the guidelines, although supervised
programs are scarcely available. This single-center observational study aimed to
evaluate the long-term outcomes of patients with PAD and claudication receiving
optimal medical care and follow-up or revascularization procedures or structured
home-based exercise.

The records of 1590 PAD patients with
claudication were assessed at the Vascular Surgery Unit between 2008 and 2017.
Based on the findings of the recruitment visit, patients were assigned to one of
the three following groups according to the available guidelines:
Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The
exercise program was prescribed at the hospital and executed at home with two
daily 10-minute interval walking sessions at a pain-free speed. The number and
date of deaths, all-cause hospitalizations, and peripheral revascularizations for
5 years were collected from the Emilia-Romagna regional database.

At entry, 137 patients underwent revascularization; 1087
patients were included in the Ex group, and 366 were included in the Co group. At
baseline, patients in the Rev group were significantly younger and had fewer
comorbidities (p
< 0.001). A propensity score matching analysis was
performed, and three balanced subgroups of 119 patients were each created. The
mortality rate was significantly (p
< 0.001) greater in the Co (45%)
group than in the Rev (11%) and Ex (11%) groups, as was the incidence of
all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; p
< 0.001).
There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%;
Ex 11%).

In PAD patients with claudication, both
revascularization procedures and structured home-based exercise sessions are
associated with better long-term clinical outcomes than walking advice and
follow-up only.

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