Surgical Intervention for Peripheral Artery Disease Does Not Improve Patient Compliance with Recommended Medical Therapy

Abstract

Nonadherence to smoking abstinence, antiplatelet therapy, and statin therapy in patients with peripheral artery disease (PAD) is associated with worse long-term outcomes. We hypothesized that patients who underwent invasive revascularization procedures would be more likely to adhere to these therapies than patients who were managed medically. Prospective survey-based interviews pertaining to medication and behavioral compliance of patients with symptomatic PAD were performed. Specifically, adherence to smoking cessation, antiplatelet therapy, and antilipid therapy was evaluated. A retrospective review of the electronic medical record was then performed to obtain procedural data and divide patients into medically managed or surgically managed (open revascularization, percutaneous revascularization, amputation) cohorts. One hundred patients met criteria for inclusion and took part in the study. Overall, 62% were nonsmokers, and 59.1% of those with a history of smoking had quit; 66.7% were adherent to statin therapy; and 72.7% were adherent to antiplatelet therapy. Among patients treated with or without surgery, respectively, there was no difference in regards to rates of smoking abstinence (64.8% vs. 55.2%, P=0.37), successful smoking cessation (61.5% vs. 53.6%, P=0.51), antiplatelet adherence (73.9% vs. 74.1%, P=0.99), or statin adherence (65.2% vs. 70.4%, P=0.24). Major amputation was also not associated with adherence to these therapies. Surgical revascularization does not influence the likelihood of adherence to smoking abstinence, smoking cessation, antiplatelet therapy, or statin therapy in patients with symptomatic PAD. Patients should be counseled regarding revascularization options with the understanding that their likelihood of medical treatment compliance will be unaffected by any proposed intervention.