Single Centre, Mid-term Clinical Outcomes of Supervised Exercise for Claudication

Abstract

Introduction: Peripheral arterial disease (PAD) causes a significant reduction in physical activity and quality of life. NICE guidelines recommend all patients with claudication should be offered best medical therapy (BMT) and enrolled into a supervised exercise programme (SEP). Despite good evidence of efficacy in patients with claudication, SEP provision varies across UK trusts and is largely dependent on local NHS budget constraints. Though SEP has been shown to be effective in improving outcomes such as claudication distance; little is known on long term outcomes and interventions such as revascularisation. We aimed to analyse the mid to long term clinical outcomes of patients enrolled in SEP. Methods: This is a single centre retrospective cohort study. 228 patients were identified from 2014 to 2018. Electronic computer records and clinical letters were interrogated for key demographic and clinical outcome information. All major lower limb clinical outcomes were analysed. Collected data was analysed using SPSS v25, survival was analysed using Kaplan-Meier method. Results: Of 228 patients, 34 were excluded due to insufficient clinical details. Mean age was 68.8 years (+/- 10.4) with a M:F ratio of 2.6:1. Hypertension (91%) and ischaemic heart disease (45%) were the commonest co-morbidities followed by Diabetes (26%). Almost 90% of patients were on a combined antiplatelet agent and statin. 90% of the cohort were either current smokers or ex-smokers. Patients completed an average of 21 SEP sessions, however 28% of the cohort attended an insufficient number of sessions to qualify as completing SEP. Mean claudication distance prior to commencing SEP was 158.1m (+/- 175.2) which increased to 548.2m (+/- 1244.4) on completion; with 69.7% showing an improvement. Off 194 participants in SEP 10% went on to have revascularisation with only 0.5% requiring major lower limb amputation. Survival analysis showed 86.5% of population to be free from intervention and major adverse limb events at 36 months' post programme. Conclusion: SEP in our cohort improved claudication distance with only a small minority progressing to require revascularisation during their time in the programme. SEP patients experienced prolonged benefits in the mid to long term with only 14.5% experiencing a major adverse limb event at 36 months. SEP patients and are at low risk of requiring major lower limb amputation. More should be done to make SEP available to all patients suffering with PAD across the UK given the evidence of improved outcomes. Disclosure: Nothing to disclose