Guideline-Adherent Care is Associated with Higher Rates of Symptom Relief in Claudicants with Surgical Intervention.

BACKGROUND: Surgical guidelines recommend intervention in claudicants with severe lifestyle limiting symptoms that have failed optimal medical therapy (OMT) and supervised exercise therapy. We investigate the rate of complete guideline-adherent care in claudicants and assess its impact on postsurgical symptom relief.

METHODS: A single institution retrospective cohort study was performed on claudicants with an endovascular/open surgical intervention from 2014 to 2023. Guideline adherence was defined as: lifestyle limitation documentation, OMT adherence (composite of single antiplatelet agent, lipid-lowering therapy, smoking cessation), and exercise therapy completion. The primary outcome was symptom relief at 1 year, defined as an improvement in walking distance or impact on activities of daily living. Statistical analysis included independent sample t-tests, Pearson χ2 tests, Kaplan-Meier analysis, and logistic regression modeling.

RESULTS: Of 258 claudicants with surgical intervention, 19% were guideline-adherent. Lifestyle limitation documentation was found in 62.4% of patients, 65.1% were on OMT, and 31% completed exercise therapy. One-year symptom relief was found in 87.8% of guideline-adherent patients, compared to 67.0% of guideline-nonadherent patients (P = 0.01). On multivariable logistic regression analysis, guideline-adherence (odds ratio [OR]: 3.31 [1.30, 8.42], P = 0.01), 5-factor modified frailty index >2 (OR: 0.48 [0.27, 0.87], P < 0.02), and prior peripheral vascular intervention (OR: 0.27 [0.13, 0.59], P < 0.01) were predictors of 1-year symptom relief.

CONCLUSION: Guideline-directed care in claudicants remains low, despite its association with 1-year symptom relief. There is increasing need for initiatives to qualitatively characterize and improve adherence rates of guideline-directed care in claudicants.