National assessment of availability, awareness, and utilization of supervised exercise therapy for peripheral artery disease patients with intermittent claudication

Dua, Anahita; Gologorsky, Rebecca C.; Savage, Dasha; Rens, Neil; Gandhi, Neil; Brooke, Benjamin S.; Corriere, Matthew A.; Jackson, Elizabeth A.; Aalami, Oliver

doi:10.1016/j.jvs.2019.08.238

Cited by 71 publications

(66 citation statements)

References 13 publications

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“…19 However, there remains uncertainty about the long term benefit of SET. 25 Furthermore, SET is often unavailable in most countries, 4 and none of the groups was entered in a formal supervised exercise programme. Instead, they were given structured exercise training advice and a free pedometer, and pedometer readouts were used to encourage ongoing exercise during follow up.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, SET is often not reimbursed or available for the majority of patients, and hence simple exercise training advice is the predominating clinical practice. 4 Invasive procedures are commonly offered to patients with IC and currently a large majority of these procedures are undertaken with minimally invasive endovascular treatment under local anaesthesia. 5 Frequently, lesions located in the superficial femoral artery (SFA) are targeted for invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

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Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Djerf

Svensson

Nordanstig

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis examination of the cost effectiveness within a randomised controlled trial for endovascular treatment of the superficial femoral artery in patients with intermittent claudication (IC) adds longer follow up data than previous studies. One hundred patients were randomised to primary stenting or non-invasive treatment. After two years of follow up, primary stenting as an adjunct to exercise training advice was a cost effective treatment option, according to Swedish national guidelines, and approaching the National Institute of Health and Care Excellence's threshold for willingness to pay. From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.Objective: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. noninvasive treatment. Methods: One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3LÔ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. Results: The mean cost per patient was V11 060 in the stent group and V4 787 in the control group, resulting in a difference of V6 273 per patient between the groups.The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of V 23 785 per QALY. Conclusion:The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < V50 000 e V70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 e £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Djerf

Svensson

Nordanstig

et al. 2021

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

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“…SET is well-known as the most effective noninvasive therapy for improving pain-free walking distances in claudicants [95] . Despite the strong evidence for SET, there have been poor SET referral rates by medical providers, with only 50% of providers making a referral in a recent national SET utilization survey [96] .…”

Section: Digital Health Tools and Digital Therapeuticsmentioning

confidence: 99%

A look to the future: Pandemic-induced digital technologies in vascular surgery

Lin

Welle

Ding

et al. 2021

Seminars in Vascular Surgery

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Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.

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“…Despite consistent evidence demonstrating the clinical effectiveness of SEPs, a European survey conducted in 2012 demonstrated that approximately 30% of the respondents had access to a supervised programme, 56 with similar availability in the UK. 19 Similar evidence has recently emerged from the USA with 54% of the respondents stating no exercise to a SEP. 20 These low provision rates may be attributed to several factors including funding provision, facilities, referral pathways, resources and a lack of trained staff. 19 23 …”

Section: Exercise Trainingmentioning

confidence: 99%

Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

Harwood

Pymer

Ingle

et al. 2020

BMJ Open Sport Exerc Med

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Peripheral artery disease (PAD) is caused by atherosclerotic narrowing of the arteries supplying the lower limbs often resulting in intermittent claudication, evident as pain or cramping while walking. Supervised exercise training elicits clinically meaningful benefits in walking ability and quality of life. Walking is the modality of exercise with the strongest evidence and is recommended in several national and international guidelines. Alternate forms of exercise such as upper- or lower-body cycling may be used, if required by certain patients, although there is less evidence for these types of programmes. The evidence for progressive resistance training is growing and patients can also engage in strength-based training alongside a walking programme. For those unable to attend a supervised class (strongest evidence), home-based or ‘self-facilitated’ exercise programmes are known to improve walking distance when compared to simple advice. All exercise programmes, independent of the mode of delivery, should be progressive and individually prescribed where possible, considering disease severity, comorbidities and initial exercise capacity. All patients should aim to accumulate at least 30 min of aerobic activity, at least three times a week, for at least 3 months, ideally in the form of walking exercise to near-maximal claudication pain.

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National assessment of availability, awareness, and utilization of supervised exercise therapy for peripheral artery disease patients with intermittent claudication

Cited by 71 publications

References 13 publications

Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

A look to the future: Pandemic-induced digital technologies in vascular surgery

Exercise training for intermittent claudication: a narrative review and summary of guidelines for practitioners

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