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Home > Vascular Annual Meeting > spronk_invasive_treatment

Invasive Treatment of Claudication Is Indicated for Patients Unable to Adequately Ambulate During Cardiac Rehabilitation

Sandra Spronk¹, John V. White², Connie Ryjewski², Judy Rosenblum², Johanna Bosch¹, Myriam Hunink.^1
1Erasmus University Medical Center, Rotterdam, The Netherlands;²Advocate Lutheran General Hospital, Park Ridge, Ill.

OBJECTIVES: Cardiac rehabilitation (CR) is of proven benefit for patients with coronary artery disease. Patients who successfully complete CR have a statistically significant reduction in the risk of fatal MI and all cause mortality. Peripheral arterial disease (PAD) is common in patients with coronary artery disease. To determine whether PAD prevents the successful completion of CR and cardiac risk reduction and whether invasive treatment of claudicants who cannot walk sufficiently to successfully complete CR is indicated.

METHODS: The records of 230 consecutive CR patients were reviewed for attendance, target heart rate, mets, and WIQ values to compare PAD among successes and failures. Failure of CR was defined as inability to walk a sufficiently to achieve target heart rate or mets. Values were compared using SPSS software. Markov decision analysis using published data for endo and open intervention for claudication was used to compare outcomes of treatment strategies in which PAD is untreated (current standard), PAD is treated only if it interfered with CR, and treatment of PAD in all patients prior to initiating CR.

RESULTS: Of 230 patients, 126 had complete records for analysis. ABIs were documented for 39 patients. Overall, 40%of patients failed cardiac rehabilitation. The presence of PAD based on the walking distance score of the WIQ was significantly higher in the failure group compared with the success group (34% vs. 17%, p=0.03; OR 2.5; 95%CI 1.1 to 6.0). The presence of PAD based upon ABI was higher in the failure group than the success group (39% vs. 14%, p=0.08, OR 3.8; CI 0.8 to 17.9). Logistic regression analysis when CR failure was adjusted for age and gender, was significantly associated with presence of PAD based upon WIQ walking distance score (p=0.03; OR 2.8; 95%CI 1.1 to 7.1). Markov analysis revealed that a strategy of invasive therapy only if PAD interfered with the successful completion of rehab would save an additional 41 lives per 10,000 patients compared with the current standard of no intervention in these patients.

CONCLUSIONS: PAD is a significant cause of CR failure, preventing patients from achieving a reduction in risk of cardiac mortality. Invasive treatment of PAD in patients who fail cardiac rehab is indicated with an expected life saving outcome.

AUTHOR DISCLOSURES: S. Spronk, travel grant; J.V. White, None; C. Ryjewski, None; J. Rosenblum, None; J. Bosch, None; M. Hunink, None.