Abstract
Aim: We retrospectively examined the impact on the rate of survival of pain-free home-based exercise in diabetic peripheral artery disease patients compared to patients receiving usual care. Methods: In total, 202 patients at Fontaine’s Stage II with diabetes were studied. Half were enrolled in a structured home-based exercise program (E), whereas the other half received walking advice as the active control group (C). Long-term clinical outcomes at five years were gathered from the Emilia-Romagna Health Service Registry, with survival probability selected as the primary outcome. Results: At baseline, the two groups did not differ for any demographic or clinical characteristics. High adherence to the program was recorded in Group E (88% of home-walking sessions executed, with an average distance walked during the program of 174 km). After five years, a survival rate of 90% for Group E and 60% for Group C was observed, with a significantly (P < 0.001) higher mortality risk for Group C [Hazard ratio (HR) = 3.92]. Additionally, among secondary outcomes, Group E showed a significantly (P = 0.048) lower rate of peripheral revascularizations than Group C (15% vs. 24%, respectively; HR = 1.91), all-cause hospitalizations (P = 0.007; 61% vs. 80%, HR = 1.58), and amputations (P = 0.049; 6% vs. 13%, HR = 2.47). In a Cox multivariate-proportional regression model of the entire population, the predictors of survival probability were age (HR = 1.05), Charlson index (HR = 1.24), lower ankle-brachial index (HR = 6.66), and control group (HR = 4.99). Conclusion: A simple sustainable program aimed at improving mobility of diabetic patients with claudication at high cardiovascular risk was associated with better survival and long-term clinical outcomes.
Highlights
Atherosclerotic peripheral artery disease (PAD) is a highly prevalent and undertreated global disease, with a negative association with premature cardiovascular events and death[1]
A simple sustainable program aimed at improving mobility of diabetic patients with claudication at high cardiovascular risk was associated with better survival and long-term clinical outcomes
PAD in diabetic subjects reflects a systemic atherosclerotic disease with peculiar characteristics, such as a high incidence of vascular calcifications[5], rapid progression toward more severe PAD stages, and prevalent involvement of distal and bilateral arteries[5]. All these factors are associated with worst long-term clinical outcomes[4,6,7] including a high risk of amputations[8], unfavorable cardiovascular outcomes, and higher mortality in diabetic PAD patients as compared to those in non-diabetic PAD patients[9,10]
Summary
Atherosclerotic peripheral artery disease (PAD) is a highly prevalent and undertreated global disease, with a negative association with premature cardiovascular events and death[1]. PAD in diabetic subjects reflects a systemic atherosclerotic disease with peculiar characteristics, such as a high incidence of vascular calcifications[5], rapid progression toward more severe PAD stages, and prevalent involvement of distal and bilateral arteries[5]. All these factors are associated with worst long-term clinical outcomes[4,6,7] including a high risk of amputations[8], unfavorable cardiovascular outcomes, and higher mortality in diabetic PAD patients as compared to those in non-diabetic PAD patients[9,10].
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