The association between completion of supervised exercise therapy and long-term outcomes in patients with intermittent claudication, concomitant sarcopenia and cardiometabolic multimorbidity.

ABSTRACT

INTRODUCTION: The combination of intermittent claudication (IC), cardiometabolic multimorbidity (CMM) and sarcopenia is associated with worse outcomes than IC alone. This study aimed to identify whether the completion of Supervised exercise therapy(SET) attenuates these adverse outcomes in patients with combined IC, sarcopenia and CMM. METHODS: This registry review included consecutive IC patients with concomitant CMM and sarcopenia, who were referred for SET from 2014 to 2017. CMM was defined as two or more comorbidities (diabetes, heart disease, stroke, or chronic kidney disease). Sarcopenia was assessed using the L3-skeletal muscle index (L3SMI) from CT scans in the preceding 18 months. Outcomes of interest were progression to chronic limb-threatening ischemia (CLTI), major adverse cardiovascular events (MACE), and major adverse limb events (MALE). Survival and Cox regression analyses were performed. RESULTS: Eighty-two patients with a combination of IC, CMM and sarcopenia were included. Of these, 56 declined or prematurely discontinued SET and 26 completed SET. Baseline characteristics and L3SMI did not significantly differ between groups. Completion of SET was associated with slower progression to CLTI (HR 0.23; 95% CI 0.07-0.69; p = 0.02) and a reduced risk of MALE (HR 0.21; 95%CI 0.057-0.775;p=0.02). However, there was no reduction in the risk of MACE (HR 0.88; 95%CI 0.423-1.629; p=0.73). Models demonstrated good predictive accuracy (Harrell's C-index>0.6). CONCLUSION: Completion of SET was associated with significant improvements in adverse limb outcomes in patients with IC, concomitant sarcopenia and CMM.