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To Treat or Not to Treat? the Fate of Patients with Intermittent Claudication Following Different Therapeutic Options

Reviews in Cardiovascular Medicine(2024)

Univ Hosp Ferrara | Univ Ferrara

Cited 0|Views8
Abstract
Background: Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise. Methods: The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database. Results: At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities (p < 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly (p < 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; p < 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%). Conclusions: In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.
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peripheral artery disease,exercise,intermittent claudication,vascular surgery,clinical outcomes,survival,hospitalizations
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要点】:间歇性跛行外周动脉疾病(PAD)患者接受血管重建或家庭结构性锻炼治疗相较于仅接受步行建议和随访可带来更好的长期临床结果。

方法】:通过单中心观察研究,将1590名PAD患者根据指南分为血管重建组、家庭结构性锻炼组以及对照组,对比分析其五年内的死亡率、全因住院率和外周血管重建率。

实验】:对2008至2017年间在血管外科单元就诊的PAD患者进行追踪,记录其死亡、住院及血管重建情况,使用Emilia-Romagna区域数据库收集数据,并进行了倾向得分匹配分析。结果显示,相较于对照组,血管重建组和锻炼组在死亡率和全因住院率上均有显著改善。