A prospective multicentre study on the treatment of cardiovascular risk factors and claudication symptoms in patients with peripheral artery disease (the IDOMENEO study)

Abstract. Background: The objective of this prospective multicentre cohort study was to characterise the use of pharmacological and non-pharmacological treatment for cardiovascular disease (CVD) risk factors and intermittent claudication (IC) symptoms in clinical practice patients with peripheral artery disease (PAD), and to determine the care gap with international guidelines and evidence-based therapy. Patients and methods: From 2011 through 2013, participating centres enrolled consecutive patients with PAD of atherosclerotic origin demonstrated by ultrasound, ankle brachial index (ABI) 0.9 and symptoms of IC. A seven item grid was built for the assessment of care gap (percentage of patients eligible for a treatment who did not receive it). Results: All patients (232) presented at least one CVC risk factor, 90.2% at least two, and 91.5% had either established CAD or cerebrovascular disease or at least two CVD risk factors. Care gap was lower than 25% for any method to stop smoking, lipid lowering agents, antiplatelet and/or anticoagulation therapy and any kind of exercise program; between 25% and 50% for ACE-inhibitors/angiotensin II antagonist therapy; between 50% and 75% for beta-blocker therapy; and higher than 75% for supervised exercise program and use of cilostazol. Patients with and without CAD/cerebrovascular disease were differently treated with clopidogrel (27.3% and 4.8%, p≤0.001), any antiplatelet/anticoagulant therapy (98.7% and 83.3%, p≤0.001) and beta-blockers (46.8% and 16.0%, p≤0.001). Conclusions: Many gaps with evidence-based recommendations are still present in the pattern of the use of pharmacological and non-pharmacological treatment for CVD risk factors and IC symptoms in clinical practice PAD patients.