Real World Practice Deviation from Nationwide Guidelines in Patients with Intermittent Claudication

Anne G.L. Aaij, Bryan Wermelink*, Marieke Haalboom, Anco C. Vahl, Robbert Meerwaldt, Robert H. Geelkerken

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
55 Downloads (Pure)


Objective: Patients with intermittent claudication (IC) are initially treated with supervised exercise therapy (SET), as advised by national and international guidelines. Dutch health insurance companies and the Dutch National Health Care Institute suggested an 87% compliance rate with these guidelines in the Netherlands in 2017 and judged this to be undesirably low. The aim of this study was to evaluate compliance with IC guidelines and to elaborate on the reasons for deviating from them (practice variation) in a large teaching hospital. Methods: A retrospective single centre cohort study was conducted at a large teaching hospital in the Netherlands. In total, 420 patients with newly diagnosed IC between 1 January 2017 and 31 December 2018 were analysed. Data included risk profiles and prescribed therapies. Results: For all 420 included patients, the compliance rate with the guidelines for SET was 80.5%. The rate of adequately motivated and defensible practice variation was 15.7%; the rate of unjustified practice variation was 3.8%. Meaningful care was seen in 96.2% of cases. Conclusion: Deviation from IC guidelines was found in 19.5% of patients. Almost three quarters of this deviation can be explained by the decision to provide personalised, meaningful care.

Original languageEnglish
Pages (from-to)432-438
Number of pages7
JournalEuropean journal of vascular and endovascular surgery
Issue number3
Early online date1 Jul 2021
Publication statusPublished - Sept 2021


  • Intermittent claudication
  • Peripheral arterial disease
  • Personalised care
  • Practice variation
  • Supervised exercise therapy
  • UT-Hybrid-D


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