{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:51:37Z","timestamp":1792097497456,"version":"4.4.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,2,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Underuse of guideline\u2010recommended therapy in peripheral artery disease (\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              ) in administrative and procedural databases has been described, but reports on medically managed patients and referral to supervised exercise therapy (\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              ) in\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              are lacking. We aimed to document the use of\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              guideline\u2010recommended therapy, including\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              in patients with\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              symptoms consulting a specialty clinic across 3 countries.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The 16\u2010center PORTRAIT (Patient\u2010Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry enrolled 1275 patients with new or an exacerbation of\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              symptoms (2011\u20132015). We prospectively documented antiplatelet medications, statins, smoking cessation counseling and\/or therapy, and referral to\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              : \u201c2 quality measures\u201d referred to the use of both statin and antiplatelet medications; \u201c4 quality measures\u201d 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\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              . Of 455 current smokers, 342 (72%) patients received smoking cessation therapy\/counseling. Overall, 77.2% of patients received \u201c2 quality measures\u201d and 19.7% \u201c4 quality measures.\u201d The median odds ratio for 2 quality measures was 2.13 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.61\u20133.56;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and for 4 quality measures was 5.43 (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 2.84\u201317.91;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Variability in adherence was not explained by country, except for referral to\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              . The odds for\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              referral in The Netherlands (70% referral rate) was nearly 100 times greater than in\n              <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>\n              sites (2% referral rate).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Not all patients who have undergone a\n              <jats:styled-content style=\"fixed-case\">PAD<\/jats:styled-content>\n              workup at a specialty care facility are treated with evidence\u2010based care, especially so for\n              <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.012541","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T10:00:33Z","timestamp":1579860033000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Adherence to Guideline\u2010Recommended Therapy\u2014Including Supervised Exercise Therapy Referral\u2014Across Peripheral Artery Disease Specialty Clinics: Insights From the International PORTRAIT Registry"],"prefix":"10.1161","volume":"9","author":[{"given":"John T.","family":"Saxon","sequence":"first","affiliation":[{"name":"Saint Luke's Mid America Heart Institute Kansas City MO"},{"name":"University of Missouri\u2013Kansas City Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Safley","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute Kansas City MO"},{"name":"University of Missouri\u2013Kansas City Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Mena\u2010Hurtado","sequence":"additional","affiliation":[{"name":"Yale University New Haven CT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Heyligers","sequence":"additional","affiliation":[{"name":"Elisabeth Hospital Tilburg The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Fitridge","sequence":"additional","affiliation":[{"name":"Queen Elisabeth Hospital Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Shishehbor","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Spertus","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute Kansas City MO"},{"name":"University of Missouri\u2013Kansas City Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensey","family":"Gosch","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manesh R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim G.","family":"Smolderen","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute Kansas City MO"},{"name":"University of Missouri\u2013Kansas City Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30255-4"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000471"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199202063260605"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.2.197"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182031a3c"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.174526"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.108787"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.11.077"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.003954"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.07.027"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.064"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000697"},{"key":"e_1_3_2_14_2","unstructured":"Cardiovascular Outcomes . 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