Novel Interventions to Improve Adherence to Guideline-Directed Medical Therapy in Claudicants

TL;DR

This review explores why patients with leg pain from poor blood flow don't follow recommended treatments and how to improve their adherence.

Contribution

The paper introduces novel initiatives to improve adherence to guideline-directed therapy and quality-of-life assessments in claudicants.

Findings

Most claudicants do not trial optimal medical therapy or supervised exercise therapy.

Barriers to adoption include lack of quality-of-life assessments and underutilization of patient-reported outcomes.

Novel initiatives aim to enhance adherence to recommended treatments and assessments.

Abstract

Intermittent claudication is the most common manifestation of peripheral arterial disease as well as a lifestyle-limiting disease with a favorable prognosis. Despite societal guideline recommendations, most claudicants do not trial optimal medical therapy (OMT) and supervised exercise therapy (SET) or receive a quality-of-life (QoL) assessment prior to intervention. In this review, we discuss the components of OMT and SET and the trials establishing their clear benefits in claudicants. We assess adherence rates to OMT/SET and qualitative and quantitative studies attempting to understand the barriers to adoption. We also review how patient-reported outcome metrics were developed to assess QoL in claudicants and reasons for their underutilization in daily clinical practice. Last, we describe novel initiatives seeking to improve adherence to OMT, SET, and QoL assessment.

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