Adherence to Guideline‐Recommended Therapy—Including Supervised Exercise Therapy Referral—Across Peripheral Artery Disease Specialty Clinics: Insights From the International PORTRAIT Registry

Background Underuse of guideline‐recommended therapy in peripheral artery disease ( PAD ) in administrative and procedural databases has been described, but reports on medically managed patients and referral to supervised exercise therapy ( SET ) in PAD are lacking. We aimed to document the use of PAD guideline‐recommended therapy, including SET in patients with PAD symptoms consulting a specialty clinic across 3 countries. Methods and Results The 16‐center PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry enrolled 1275 patients with new or an exacerbation of PAD symptoms (2011–2015). We prospectively documented antiplatelet medications, statins, smoking cessation counseling and/or therapy, and referral to SET : “2 quality measures” referred to the use of both statin and antiplatelet medications; “4 quality measures” to receiving all 4 measures. Median odds ratios were calculated to quantify treatment variation across sites. A total of 89% patients were on antiplatelets, 83% on statins, and 23% had been referred to SET . Of 455 current smokers, 342 (72%) patients received smoking cessation therapy/counseling. Overall, 77.2% of patients received “2 quality measures” and 19.7% “4 quality measures.” The median odds ratio for 2 quality measures was 2.13 (95% CI , 1.61–3.56; P <0.001) and for 4 quality measures was 5.43 (95% CI , 2.84–17.91; P <0.001). Variability in adherence was not explained by country, except for referral to SET . The odds for SET referral in The Netherlands (70% referral rate) was nearly 100 times greater than in US sites (2% referral rate). Conclusions Not all patients who have undergone a PAD workup at a specialty care facility are treated with evidence‐based care, especially so for SET .