Abstract 20126: Factors Associated With Referral to Exercise Therapy in Patients With Peripheral Arterial Disease: Insights From the PORTRAIT Registry

Introduction: Exercise therapy (ET) is the mainstay of treatment for symptomatic peripheral arterial disease (PAD). However, data on referral rates and factors associated with ET referral are scarce. Objectives: To identify independent predictors of ET referral and examine site-level variation in referral rates in an international cohort of newly evaluated patients with symptomatic PAD. Methods: Patients with new or an exacerbation of PAD symptoms from 16 PAD specialty care centers were enrolled between June 2011 and October 2015 in the Patient-centered Outcomes Related to TReatment practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT) registry. Hierarchical mixed model logistic regression, with and without adjustment for prior ET, were used to identify independent predictors of ET referral (supervised or unsupervised) during the first PAD specialist care visit. Site-level variation in ET referral was also analyzed. Results: Of 1,276 symptomatic PAD patients (mean age 67.6 years, 37.9% women), 735 (57.6%) were referred to ET (21.9% to supervised ET) following their PAD work-up. Compared with patients not referred to ET, those referred were more likely to be women, non-white, have a lower prevalence of alcohol abuse, anxiety or depression, and prior CABG, and have higher baseline peripheral artery questionnaire (PAQ) summary scores (indicating better functioning) and prior ET referral rates. In the multivariable model, higher baseline PAQ summary scores were independently associated with a greater odds of ET referral (Figure 1). Significant variation was observed in ET referral rates across sites (median odds ratio 6.61; 95% CI 2.31-12.63). Conclusions: Overall, ET in symptomatic PAD patients is prescribed in just over half of patients with significant site-level variability. Further investigation is needed to understand why patients with better perceived PAD specific health status are more likely to be referred for ET.