Lower extremities peripheral arterial disease among patients admitted to cardiac rehabilitation: The THINKPAD registry

Ambrosetti, Marco; Temporelli, Pier Luigi; Faggiano, Pompilio; Febo, Oreste; Diaco, Tommaso; Favretto, Giuseppe; Calisi, Pasqualina; Gabriele, Michele; Greco, Cesare; Tavazzi, Luigi

doi:10.1016/j.ijcard.2013.12.004

Cited by 16 publications

(6 citation statements)

References 20 publications

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“…96 Despite this evidence, PAD patients are referred to cardiac rehabilitation only in a minority of cases and often when associated with other cardiovascular conditions. 97 In the modern era, cardiac rehabilitation centres should give more consideration to PAD patients as a target group, thus expanding the usual indication of intermittent claudication and considering patients with atypical symptoms or after surgical/percutaneous revascularization also.…”

Section: Peripheral Artery Diseasementioning

confidence: 99%

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

Ambrosetti

Abreu

Corrà

et al. 2020

European Journal of Preventive Cardiology

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525

604

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Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and ‘modern’ cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.

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Section: Peripheral Artery Diseasementioning

confidence: 99%

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

Ambrosetti

Abreu

Corrà

et al. 2020

European Journal of Preventive Cardiology

Self Cite

525

604

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show abstract

“…A survey carried out by the Vascular Society of Great Britain and Ireland in the year 2009, as for instance, revealed that only 24% of UK resident surgeons had access to SET for LEPAD patients [23], being presumably this estimate even less when considering a multimodal CR intervention instead of exercise only. Then, when specifically referred for their condition, LEPAD patients constitute a minority of all patients engaged to CR, with a prevalence varying from less than 1% to 7% [12,24].…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, the IACPR carried out an educational project (i.e. the THINKPAD "ATHerosclerosis of the lower extremIties as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation" project), aimed at increasing the awareness of the cardiac rehabilitation community about LEPAD, also supported by national multicentre observational studies [12]. As a second step, the IACPR organized an operational network by coupling five CR units with five another neighbouring vascular surgery facilities, on a voluntary basis, and facilitated local relationships and policies in order to take LEPAD into account as a qualified condition for rehabilitation within this closed network.…”

Section: Methodsmentioning

confidence: 99%

Referral from vascular surgery to cardiovascular rehabilitation and related outcomes in patients with peripheral arterial disease: the THINKPAD-RELOADED survey

Ambrosetti

Faggiano

Greco

et al. 2019

Monaldi Arch Chest Dis

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The utilization of cardiovascular rehabilitation (CR) programmes in patients with Lower Extremity Peripheral Artery Disease (LEPAD) is generally poor, with limited evidence of current policies for referral. The aim of the study was to evaluate, within a cohesive network of CR and vascular surgery facilities with facilitated referral process, the clinical characteristic of LEPAD patients referred to CR and related outcomes, as compared to patients not referred. The present is an observational prospective study of consecutive patients recruited at vascular surgery facilities. Out of 329 patients observed, the average referral rate to CR was 34% (28% and 39% in patients with and without recent peripheral revascularization, p<0.05). LEPAD patients entering the CR programme were similar to those who did not according to sex, age, the vascular surgery setting of evaluation, and localization of arterial lesions. Patients with moderate intermittent claudication and patients with acute limb ischemia as index event were more represented among those who attended CR (41% vs 21% and 9% vs 2% respectively, p<0.05). Patients referred to CR had five times more episodes of acute coronary syndrome and heart failure as complication of the index event. The cardiovascular risk profile (obesity 29.5% vs 11%, p<0.05; hypercholesterolemia 80% vs 61%, p<0.05) was much worse in LEPAD patients referred to CR, but conversely, they better achieved secondary prevention targets, particularly for blood pressure control (97% vs 57%, p<0.05). All-cause 2-year mortality in the whole patients’ population was 6%. Patients entering the CR programme displayed less events (13.5% vs 37.7%, p<0.05), mainly death (3.1% vs 11.3%, p<0.05) and limb-related events (4.2% vs 15.2%, p<0.05). The results of our study suggest that when a cohesive network of vascular surgery and CR facilities becomes available, the referral rate to rehabilitation may increase up to one third of eligible patients. Patients with higher comorbidity and cardiovascular risk seem to have priority in the referral process, nevertheless those with peripheral revascularization are still underestimated. Entering CR may ensure better cardiovascular risk profile and cardiovascular prognosis in LEPAD patients, and consequently the systematic adoption of this care model needs to be strongly recommended and facilitated.

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“…Screening for gender-based violence is important, as this is more prevalent in women and negatively impacts CVD outcomes as well. 24,52 A careful clinical history should be taken, ensuring comprehensive assessment to minimize any safety issues due to unidentified cardiac or other issues, given women often have other forms of heart disease and diagnostic tests are less sensitive in women than men. 1 This should also include consideration of history of cancer due to the cardiotoxicity of some treatments, 53 as well as comorbidities more common in women that may complicate prognosis, such as autoimmune conditions.…”

Section: Intake Assessmentmentioning

confidence: 99%

Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Ghisi

Marzolini²,

Price³

et al. 2022

Canadian Journal of Cardiology

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Lower extremities peripheral arterial disease among patients admitted to cardiac rehabilitation: The THINKPAD registry

Cited by 16 publications

References 20 publications

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

Referral from vascular surgery to cardiovascular rehabilitation and related outcomes in patients with peripheral arterial disease: the THINKPAD-RELOADED survey

Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

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