Counseling Interventions for Walking reduce risk of CV Events in Peripheral Artery Disease, finds study

New research revealed that counseling interventions to increase walking and physical activity have reduced the risk of major adverse cardiovascular events (MACE) and cardiovascular deaths in individuals with peripheral artery disease. The trial which is a post hoc analysis published the results in the journal JAMA Surgery. 

Peripheral artery disease (PAD) is a condition where blood flow to the limbs is reduced due to narrowing of the arteries. This results in walking impairment and increased risk of cardiovascular events. It is a global disease-causing increased risk of heart diseases and stroke. Structured exercise programs significantly improve walking ability and quality of life (QOL) in individuals with peripheral artery disease (PAD). However, access to these programs is often limited, and many patients struggle to maintain the walking improvements over time. Research has shown that short-term benefits are achievable through structured exercise and long-term walking improvements often diminish once formal programs end. Effective long-term strategies could not only enhance mobility but also improve overall cardiovascular health and reduce the risk of adverse events in this population. Hence, Brief Behavioral Intervention by Allied Health Professionals to Promote Physical Activity Interventions for PAD is a randomized clinical trial that was conducted in Australia to offer new hope for patients suffering from PAD. 

The trial is a parallel, multicenter randomized clinical trial that examined a counseling intervention. It was conducted between January 2015 and August 2023 involving 200 participants from vascular departments in Brisbane, Sydney, and Townsville. Participants who experienced walking difficulties due to PAD were randomly assigned to either a counseling intervention group or a control group. The counseling group were given four brief sessions designed to help them overcome challenges related to increasing physical activity, specifically walking. The primary outcome of the trial was to measure the difference in MACE risk between the two groups.

Findings:

• The median age of the participants was 70 years, with 28% being female.
• Over the average follow-up period of 3.5 years, a total of 31 individuals experienced a MACE, including 19 heart attacks, 4 strokes, and 8 cardiovascular-related deaths.
• The study showed promising results.
• Participants who received counseling were significantly less likely to experience a MACE compared to those in the control group (9.8% vs. 21.4%).
• There was a 57% reduction in the risk of cardiovascular events in Intervention group (hazard ratio [HR], 0.43; 95% CI, 0.20-0.91; P = .03).
• Further analysis suggested that improvements in disease-specific quality of life (QOL) were a key factor in reducing MACE risk.
• The likelihood of MACE was reduced with higher scores on the Intermittent Claudication Questionnaire (ICQ) and the PAD Quality of Life (PADQOL) survey at four and twelve months. 
• However, no statistically significant results were seen between counseling and cardiovascular events when the analysis was adjusted for the QOL improvements. 

The trial results highlight the potential benefits of counseling interventions aimed at increasing physical activity in PAD patients, possibly due to their positive impact on quality of life. While more research is needed, this trial suggests a promising strategy for reducing cardiovascular risk in a vulnerable population. 

Further reading:

Golledge J, Venn A, Yip L, et al. Counseling Intervention and Cardiovascular Events in People With Peripheral Artery Disease: A Post Hoc Analysis of the BIP Randomized Clinical Trial. JAMA Surg. Published online August 21, 2024. doi:10.1001/jamasurg.2024.3083