Patterns and determinants of use of pharmacological therapies for intermittent claudication in PAD outpatients: results of the IDOMENEO study.
BACKGROUND
Peripheral arterial disease (PAD) usually presents with intermittent claudication (IC). The aim of the present study was to assess, in clinical practice, the pattern of use of pharmacological therapies for IC in stable PAD outpatients.


METHODS
A propensity analysis was performed using data from the IDOMENEO study, an observational prospective multicenter cohort study. The association between any pharmacological symptomatic IC therapy with different variables was investigated using generalized linear mixed models with pharmacological therapy as response variable and binomial error.


RESULTS
Study population: 213 patients, male sex 147 (69.0%), mean age 70.0±8.6 years. Only 36.6% was under pharmacological treatment for IC, being cilostazol the most used medication (21.6%). Univariate analysis showed a probability of a patient of being assigned to any pharmacological symptomatic IC therapy of 67.0% when Ankle-Brachial Index (ABI) <0.6 and 29.8% when ABI>0.6 (P=0.0048), and a propensity to avoid pharmacological treatment for patients with a high number of drugs to treat cardiovascular risk factors (probability of 55.2% for <4 drugs and 19.6% for >4 drugs, P=0.0317). Multivariate analysis confirmed a higher probability of assigning treatment for ABI<0.6 (P=0.0274), and a trend to a lower probability in patients under polypharmacy (>4 drugs: OR=0.13, P=0.0546).


CONCLUSIONS
In clinical practice, only one third of stable outpatients with IC used symptomatic pharmacological therapy for IC. We found a propensity of clinicians to assign any symptomatic pharmacological IC therapy to patients with lower values of ABI and a propensity to avoid this kind of treatment in patients under polypharmacy.
Center for Studies and Research, Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy.
Claudio
C
Cimminiello
Center for Studies and Research, Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy - hernanemilio.polofriz@asst-vimercate.it.|Unit of Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Monza-Brianza, Italy.
Hernan
H
Polo Friz
G. A. Maccacaro Laboratory of Medical Statistics, Epidemiology and Biometry, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Giuseppe
G
Marano
Unit of Internal Medicine, Medical Department, Carate Hospital, Carate Brianza, Monza-Brianza, Italy.
Guido
G
Arpaia
G. A. Maccacaro Laboratory of Medical Statistics, Epidemiology and Biometry, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Patrizia
P
Boracchi
Unit of Internal Medicine, Medical Department, Vimercate Hospital, Vimercate, Monza-Brianza, Italy.
Gabriella
G
Spezzigu
Department of Vascular Medicine, Castelfranco Veneto Hospital, Castelfranco Veneto, Treviso, Italy.
Adriana
A
Visonà
D000368:Aged; D055109:Ankle Brachial Index; D000077407:Cilostazol; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007383:Intermittent Claudication / Q000188:drug therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D010349:Patient Compliance; D058729:Peripheral Arterial Disease / Q000150:complications*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019338:Polypharmacy; D011446:Prospective Studies; D012307:Risk Factors; D013777:Tetrazoles / Q000627:therapeutic use*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol