PAD patients minimize risk when they listen to their doctors
Patients with peripheral artery disease (PAD) who adhere to pre-operative guideline-directed care (GDC) are much more likely to avoid major adverse limb events (MALEs) up to two years after intervention.
This was the finding from researchers at the Medical University of South Carolina (MUSC) who looked at the impact of GDC for patients with claudication at the Society for Vascular Surgery’s annual meeting this week.
“Our study was designed to establish the evidence of a comprehensive multidisciplinary approach before considering surgical intervention,” co-author Richard Shi, MD, a vascular surgery resident at MUSC, said in a statement. “Too often, surgery is viewed in isolation rather than as one part of a broader continuum of care. By highlighting the role of pre-operative guideline-directed care over immediate intervention or intervention in isolation, we hope to encourage more coordinated care pathways and improved patient outcomes.”
The study enrolled 258 patients who underwent vascular surgery and evaluated if adherence to GDC before surgical intervention was associated with improved long-term limb outcomes. GDC included lifestyle limitations, exercise and optimal medical therapy.
Researchers evaluated whether adherence to GDC, and the degree of adherence, before surgical interventions improved outcomes. Adherence was evaluated in three areas. The first was documentation of severe lifestyle-limiting symptoms. They also looked at adherence to optimal medical therapy (OMT), including single antiplatelet therapy, lipid-lowering therapy and smoking cessation. The third area was completion of exercise therapy that was either supervised, or a structured home walking program prescribed by a vascular surgeon or physical therapist. Patients had to completed the exercise program for at least three months before intervention. The study's primary outcome measure was freedom from MALEs over two years following treatment.
While non-adherence to GDC was seen in 12.8% of cases, 73.3% of patients demonstrated partial adherence (OMT only) and 12.8% completely adhered. At two years, MALE occurred in 23.3% of patients, mostly due to re-interventions. A Kaplan-Meier analysis demonstrated patients with non-adherence had a MALE-free survival rate of 66.6%, compared with 76.7% with partly adherent patients and 87.9% with patients who had complete GDC adherence.
“This study highlights the important role vascular surgeons and interventionalists have in ensuring that patients meet the full continuum of pre-operative, guideline-directed care before offering surgery,” senior author Adam Tanious, MD, associate professor with the division of vascular surgery at MUSC, said in a statement. “These findings reinforce the importance of surgical appropriateness in claudicants and emphasize the need for established guidelines and pathways to direct care for this patient population.”
Researchers have found that the biggest obstacle to improving outcomes is getting patients to stick with guideline-directed care. To combat non-adherence, the MUSC researchers said they developed an electronic health record-based clinical pathway to help claudicants receive GDC prior to surgery. They are currently running a prospective study at MUSC with more than 100 patients enrolled and hope to present the findings data at a future society meeting.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]