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

Abstract

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.