Closing GDMT Gaps in PAD Patients During Supervised Exercise Therapy

Peripheral artery disease carries high cardiovascular risk. Although supervised exercise therapy (SET) improves function, uptake of guideline-directed medical therapy (GDMT) is inconsistent in practice.

We observed frequent missed opportunities for GDMT among patients with peripheral artery disease who were referred to a high-touch SET program.

In phase 1 of a multiphase quality improvement initiative, we retrospectively analyzed 60 consecutive SET referrals (January 2023-March 2025); 41 patients had complete follow-up and were included in the final analysis. At follow-up, 51% were on GDMT, 29% had never started, and 20% had discontinued. Patients on GDMT showed the most favorable physiologic change according to metabolic equivalents of task (+0.33), whereas non-GDMT groups declined (-0.18 to -0.27). Symptom relief and walking improvement were common across groups but were most consistent with GDMT. Findings will inform phase 2 interventions: electronic medical record prompts, provider feedback, and patient outreach.

Substantial GDMT care gaps persist even within SET. Embedding clinical decision support, feedback, and outreach is the next step to translate functional gains into durable vascular protection.