Peripheral arterial disease and cardiac rehabilitation: a call to action in lifestyle and cardiovascular risk factor control - a cross sectional study

Background

The latest cardiac rehabilitation (CR) guidelines in Ireland advocate this evidence-based (Class IA) opportunity for exercise-based rehabilitation and intensive risk factor modification in patients with peripheral arterial disease (PAD).

Aim

This cross-sectional study aimed to determine whether referral to CR and other key recommendations made by the Joint European Societies guidelines on secondary cardiovascular prevention are being achieved in everyday practice in patients with PAD.

Methods

Fifty-six patients with PAD were recruited from the University Hospital Galway outpatient vascular clinic. Physical activity status was objectively measured using a research-grade accelerometer (activPAL), worn on the thigh 24h/day for seven consecutive days. Daily participation in moderate to vigorous intensity physical activity (MVPA) and sitting time were recorded. Hospital records were examined with an interview-based assessment to record CR referral/attendance and the current status of other cardiovascular disease (CVD) risk factors. Statistical Package for Social Sciences (SPSS) version 27 was used to report proportion of patients meeting key guideline recommendations for CR and CVD risk factors.

Results

71% of participants were males, with a mean age of 69 years (+10 years). The mean ankle brachial index was 0.7 (+0.2). Proportions meeting key CVD prevention targets were low (table 1). Table 1: Proportion of PAD patients meeting key Joint European Societies guidelines on secondary cardiovascular prevention targets.

Conclusion

Despite recommendations, not a single PAD patient in this cohort was offered CR, with none achieving objectively measured MVPA participation recommendations. A large proportion presented with unhealthy lifestyles in terms of tobacco exposure, sedentary time and BMI; all adversely impacting major CVD risk factors. Whilst most were prescribed antiplatelet medications, yet a large cohort were not optimally managed for blood pressure and lipids. These findings support a call to action for CR provision in this patient population at very high CVD risk. CR provides an essential intervention in addressing all aspects of lifestyle and risk factor management to reduce recurrent cardiovascular events.