Abstract 19190: Effectiveness of Supervised Exercise Therapy for the Treatment of Intermittent Claudication in Real-world Clinical Practice

Abstract

Introduction: Guidelines recommend supervised exercise therapy (SET) as a first-line treatment for patients with intermittent claudication. In trials, SET has indeed been shown to be equally effective as endovascular revascularization in improving walking performance and quality of life. However, SET is an underutilized treatment and the effectiveness of a SET-first approach outside a trial setting is unknown. Hypothesis: We assessed the hypothesis that SET is an effective treatment for intermittent claudication in real-world clinical practice. Methods: In a single-center prospective cohort study, 204 patients with newly diagnosed intermittent claudication were referred to a physiotherapist for SET between August 2009 and December 2013. All patients underwent lower extremity CTA or MRA imaging. Significant stenosis was defined as ≥50% reduction in luminal diameter. Community-based SET was provided according to national guidelines. Freedom from endovascular or open surgical intervention at the last outpatient visit was considered as the primary outcome. Kaplan Meier estimate was used to determine freedom from intervention at 1 year. Results: Mean age was 70±10 years with 59% men and the common risk factors (77% hypertension, 31% diabetes, 46% smoking, 10% obesity) and comorbidities (32% and 23% history of ischemic heart or cerebrovascular disease, resp.). Median maximum walking distance on treadmill testing at baseline visit was 320 m (IQR 150-510 m). The majority (88%) of patients had significant femoropopliteal and/or crural disease. Only 4% had isolated aortoiliac and/or common femoral artery stenoses. Of the 204 referred patients, 84% followed the SET program. After 1 year follow up, 88% of patients were still free from endovascular or surgical intervention. Conclusions: In a real-world clinical setting, a SET-first approach is an effective treatment for intermittent claudication, preventing invasive treatment in most patients.