Abstract P144: Determinants of Invasive Treatment in Intermittent Claudication: Insights from Real-World Clinical Practice

Abstract

Background: Guideline-recommended care for intermittent claudication (IC) preferentially consists of conservative treatment with exercise therapy and optimal pharmacotherapy. Although health status, anatomic lesion location, and cardiovascular risk considerations need to be taken into account when referring patients with IC for invasive vs. conservative therapy, it is unknown whether these factors and site variations are associated with the decision to offer patients with IC invasive revascularization in real-world clinical practice. Methods: A total of 407 patients with IC, enrolled from 2 hospitals in The Netherlands, completed a health status survey (SF-12, Physical Component Scale [PCS]) upon diagnosis. Patients' primary treatment strategies: invasive (bypass surgery, endovascular therapy) vs. conservative ([un]supervised exercise therapy) administered ≤1 year following diagnosis, ankle-brachial index (ABI), and risk factors were documented from their medical charts. Lesion location (proximal vs. distal) was documented from duplex ultrasound readings. Multivariable Poisson regression analysis sequentially included (1) demographics, hospital site, PCS; (2) lesion location; (3) ABI and risk factors to identify predictors of invasive vs. conservative therapy. Results: Of 407 patients, 150 (36.9%) received invasive treatment. Patients with poorer health status were more likely to be referred for invasive therapy (adjusted for demographics, site RR=0.98, 95%CI 0.97-0.99, P=0.017); this association was explained by proximal lesion location (P<0.001). Proximal lesions (RR=3.94, 95%CI 2.75-5.64, P<0.001) and site (RR=2.00, 95%CI 1.27-3.23, P=0.003) were independently associated with invasive therapy in the final model. Conclusions: More than one third of patients with IC were treated invasively 1 year following diagnosis. Although lower health status and proximal lesion location were considered in providers' decision to refer patients for invasive treatment, hospital location also determined the type of treatment strategy patients would get. Future efforts will further need to evaluate the appropriateness of use of invasive treatment in IC, in order to improve quality of care and reduce site variations in care.