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Haque MZ, Reesha S, Khan S, Rafique R, Saleem A, Ilyas O, Abdullah L, Hussain A, Husain M. Peripheral Arterial Diseases and Diabetes Mellitus: Associations With Quality of Health Measures in Patients Undergoing Percutaneous Vascular Interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:34-38. [PMID: 36379829 DOI: 10.1016/j.carrev.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is more prevalent and severe in patients with diabetes mellitus (DM) compared with those without DM. Peripheral vascular intervention (PVI) is often used in patients failing conservative management. The association of PVI with health status in diabetic patients has yet to be determined. METHODS We analyzed the clinical response to PVI in DM (n = 203, 52 %) compared with non-DM patients (n = 183, 48 %), using the Peripheral Arterial Questionnaire (PAQ) for patients during baseline and a maximum 6 months after PVI. We used the PAQ summary score, which summarized the patients' level of physical and social function, patient symptoms, and overall quality of life. This represented the PAD-related Quality of Health (QOH). Our score range is between 0 (lowest health quality) and 100 (highest health quality). RESULTS Compared with non-DM patients, those with DM were more likely to have a history of prior PVI, an increased prevalence of PAD risk factors, and significantly lower QOH scores at baseline (32.7 ± 20 vs 37.5 ± 20.6, p = 0.02). After adjustment for baseline confounding, neither the baseline, the change, nor the final summary scores were significantly different between groups, suggesting similar symptomatic and functional improvement in non-DM and DM patients post-PVI. CONCLUSIONS Following PVI, PAD-specific health status showed a similar improvement in patients with and without DM, illustrating that use of this strategy among patients with multiple comorbidities or diffuse PAD as useful.
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Affiliation(s)
- Mahfujul Z Haque
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Syeda Reesha
- Downriver Heart and Vascular Specialists, Southgate, MI, USA
| | - Shahrin Khan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Rumyah Rafique
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Omar Ilyas
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | | | - Arif Hussain
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Mashkur Husain
- Downriver Heart and Vascular Specialists, Southgate, MI, USA
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Smolderen KG, Alabi O, Collins TC, Dennis B, Goodney PP, Mena-Hurtado C, Spertus JA, Decker C. Advancing Peripheral Artery Disease Quality of Care and Outcomes Through Patient-Reported Health Status Assessment: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e286-e297. [PMID: 36252117 DOI: 10.1161/cir.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Peripheral artery disease (PAD) is chronic in nature, and individualized chronic disease management is a central focus of care. To accommodate this reality, tools to measure the impact and quality of the PAD care delivered are necessary. Patient-reported outcomes (PROs) and instruments to measure them, that is, PRO measures, have been well studied in the research and clinical trial context, but a shift toward integrating them into clinical practice has yet to take place. A framework to use PRO measures as indicators of the quality of PAD care delivered, that is, PRO performance measures (PRO-PMs), is provided in this scientific statement. Measurement goals to consider by PAD clinical phenotypes are provided, as well as an overview of potential benefits of adopting PRO-PMs in the clinical practice of PAD care, including reducing unwanted variability and promoting health equity. A central discussion with considerations for risk adjustment of PRO-PMs, individualized PAD care, and the need for patient engagement strategies is offered. Furthermore, necessary conditions in terms of required competencies and training to handle PRO-PM data are discussed because the interpretation and handling of these data come with great responsibility and consequences for designing care that adopts a broader framework of risk that goes beyond the inclusion of biomedical variables. To conclude, health system perspectives and an agenda to reach the next steps in the implementation of PRO-PMs in PAD care are offered.
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Fereydooni A, Yawary F, Sen S, Chou L, Murphy M, Dalman RL, Stern JR, Chandra V. Multidisciplinary extremity preservation program improves quality of life for patients with advanced limb threat. Ann Vasc Surg 2022; 87:302-310. [PMID: 35803456 DOI: 10.1016/j.avsg.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The need for multidisciplinary care of patients with advanced limb threat is well established. We examined patient reported outcomes and health-related quality of life (HR-QoL) for those who completed a multidisciplinary extremity preservation program (EPP) at our institution. METHODS Patients with advanced limb threat, who had previously failed standard management at a tertiary-care center, were referred to EPP for evaluation by a multidisciplinary panel of vascular, plastic, orthopedic and podiatric surgeons, along with infectious disease, prosthetics, orthotics, imaging, palliative care, social work and wound nursing specialists. HR-QoL was quantified before and after EPP participation with the RAND-36 questionnaire. The validated RAND-36 assesses physical function, role limitations caused by physical and emotional health problems, social functioning, emotional well-being, energy, pain and general health perceptions. RESULTS From 2018 to 2020, 185 patients were referred to EPP. After review by the multidisciplinary panel, 120 were accepted into the program, 63 of whom completed their course of care; 9 were one-time consultations. The median number of EPP in-person care visits was 23 (13-54) per participant; 87.3% of patients received one or more surgical procedure, including operative debridement (73%), revascularization (44%), soft tissue reconstruction or transplantation (46%), as well as hyperbaric oxygen therapy (11%) during their course of treatment. 85.7% of patients achieved complete wound healing, 41.5% occurring within 6 months. Ultimately, 14.3% required a major amputation. Graduates noted improvement in all categories of the HR-QoL upon completion, including those undergoing major amputation. On adjusted multivariate regression analysis, patients with immunocompromised status were more likely to show greater improvement in their social function (OR: 10.1; P<0.044) and emotional role limitation (OR:8.1; P=0.042), while patients with larger wound volume at presentation were more likely to have greater improvement in their general health (OR: 1.1; P<0.049). Conversely, patients with a smoking history had less improvement in energy level (OR:0.4; P=0.044) and patients with dialysis-dependence had less improvement in social function (OR:0.2; P=0.034). CONCLUSION Coordinated, multidisciplinary extremity preservation program improves HR-QoL of patients with complex limb threat, including those who are immunocompromised with impaired social function and emotional role limitations. Further study is warranted to better characterize the generalizability of this approach, including considerations of cost-effectiveness, wound recidivism, and limiting the number of in-person visits required to achieve complete healing.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Farishta Yawary
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Subhro Sen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Loretta Chou
- Department of Orthopedic Surgery, Stanford University, Stanford, CA
| | - Matthew Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Ronald L Dalman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Jordan R Stern
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA
| | - Venita Chandra
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
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Tran AT, Spertus JA, Mena-Hurtado CI, Jones PG, Aronow HD, Safley DM, Malik AO, Peri-Okonny PA, Shishehbor MH, Labrosciano C, Smolderen KG. Association of Disease-Specific Health Status With Long-Term Survival in Peripheral Artery Disease. J Am Heart Assoc 2022; 11:e022232. [PMID: 35132874 PMCID: PMC9245831 DOI: 10.1161/jaha.121.022232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD‐specific health status around the time of diagnosis may prognosticate long‐term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3‐month, and change from baseline to 3‐month follow‐up. Kaplan‐Meier using 3‐month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5‐year all‐cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3‐month, respectively), 141 (19.8%) died over a median follow‐up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per‐10‐point increment; 95% CI, 0.84–0.97; P=0.008), 3‐month (HR [95% CI], 0.87 [0.82–0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85–0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3‐month PAQ was more strongly associated with mortality than either baseline (3‐month HR [95% CI], 0.85 [0.78–0.92]; P<0.001; C‐statistic, 0.77) or change (3‐month HR [95% CI], 0.79 [0.72–0.87]; P<0.001). Conclusions PAD‐specific health status is independently associated with 5‐year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.
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Affiliation(s)
- Andy T Tran
- Department of Medicine University of California Irvine School of Medicine Orange CA
| | - John A Spertus
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Carlos I Mena-Hurtado
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT
| | - Philip G Jones
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Herbert D Aronow
- Department of Medicine Alpert Medical School of Brown University Providence RI
| | - David M Safley
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Ali O Malik
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Poghni A Peri-Okonny
- Cardiovascular Research Saint Luke's Mid America Heart Institute Kansas City MO.,Department of Biomedical and Health Informatics of Medicine University of Missouri-Kansas City Kansas City MO
| | - Mehdi H Shishehbor
- Interventional Cardiovascular Center Case Western Reserve University School of Medicine Cleveland OH
| | - Clementine Labrosciano
- The Queen Elizabeth Hospital Adelaide Medical School University of Adelaide SA Australia
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program Section of Cardiovascular Medicine Department of Internal Medicine Yale University New Haven CT.,Department of Psychiatry School of Medicine, Yale University New Haven CT
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Rymer JA, Narcisse D, Cosiano M, Tanaka J, McDermott MM, Treat-Jacobson DJ, Conte MS, Tuttle B, Patel MR, Smolderen KG. Patient-Reported Outcome Measures in Symptomatic, Non-Limb-Threatening Peripheral Artery Disease: A State-of-the-Art Review. Circ Cardiovasc Interv 2021; 15:e011320. [PMID: 34937395 DOI: 10.1161/circinterventions.121.011320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-reported outcome measures (PROMs) are health outcomes directly reported by the patient that can be used to measure the effect of disease and treatments on patient perceived well-being. This review summarizes current evidence regarding the validation of PROMs in people with symptomatic, nonlimb-threatening peripheral artery disease. A literature search was conducted to identify studies of symptomatic peripheral artery disease without limb-threatening ischemia that included PROMs and had sample sizes ≥25. PROMs were summarized along a continuum of validation using classical test theory framework and according to whether they fulfilled defined criteria for (1) content validity; (2) psychometric validation; and (3) further validation evidence base expansion. Of 2198 articles identified, 157 (7.1%) met inclusion criteria. Twenty-four PROMs in patients with symptomatic peripheral artery disease were reviewed. Among disease-specific PROMs, 8 of 15 had excellent reliability as measured by a Cronbach alpha ≥0.80. Based on established criteria for PROM responsiveness, 6 of 15 disease-specific PROMs demonstrated excellent sensitivity to change. Of these, the disease-specific peripheral artery questionnaire, vascular quality of life questionnaire, and walking impairment questionnaire met criteria for validation at each stage of the continuum. For generic (nondisease specific) PROMs, the European Quality of Life 5-Dimension and SF-36 had the most extensive evidence of validation. Evidence from this review can inform selection of PROMs aligned with scientific and clinical goals, given the variable degree of validation and potential complementary nature of the measures.
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Affiliation(s)
- Jennifer A Rymer
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Dennis Narcisse
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Michael Cosiano
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - John Tanaka
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | | | - Michael S Conte
- University of California San Francisco School of Medicine (M.S.C.)
| | - Brandi Tuttle
- Duke University Center Medical Library, Durham, NC (B.T.)
| | - Manesh R Patel
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
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Gates M, Tang AR, Godil SS, Devin CJ, McGirt MJ, Zuckerman SL. Defining the relative utility of lumbar spine surgery: A systematic literature review of common surgical procedures and their impact on health states. J Clin Neurosci 2021; 93:160-167. [PMID: 34656241 DOI: 10.1016/j.jocn.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/18/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Degenerative lumbar spondylosis is a common indication for patients undergoing spine surgery. As healthcare costs rise, measuring quality of life (QOL) gains after surgical procedures is critical in assessing value. We set out to: 1) compare baseline and postoperative EuroQol-5D (EQ-5D) scores for lumbar spine surgery and common surgical procedures to obtain post-operative quality-adjusted life year (QALY) gain, and 2) establish the relative utility of lumbar spine surgery as compared to other commonly performed surgical procedures. A systematic literature review was conducted to identify all studies reporting preoperative/baseline and postoperative EQ-5D scores for common surgical procedures. For each study, the number of patients included and baseline/preoperative and follow-up mean EQ-5D scores were recorded, and mean QALY gained for each intervention was calculated. A total of 67 studies comprising 95,014 patients were identified. Patients with lumbar spondylosis had the worst reported QOL at baseline compared to other surgical cohorts. The greatest QALY gain was seen in patients undergoing hip arthroplasty (0.38), knee arthroplasty (0.35) and lumbar spine surgery (0.32), nearly 2.5-fold greater QALY gained than for all other procedures. The low preoperative QOL, coupled with the improvements offered with surgery, highlight the utility and value of lumbar spine surgery compared to other common surgical procedures.
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Affiliation(s)
- Marcus Gates
- Department of Neurological Surgery, Wellstar Health System, Austell, GA, United States
| | - Alan R Tang
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saniya S Godil
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Clint J Devin
- Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, United States
| | - Matthew J McGirt
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, United States
| | - Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
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Peri-Okonny PA, Wang J, Gosch KL, Patel MR, Shishehbor MH, Safley DL, Abbott JD, Aronow HD, Mena-Hurtado C, Jelani QUA, Tang Y, Bunte M, Labrosciano C, Beltrame JF, Spertus JA, Smolderen KG. Establishing Thresholds for Minimal Clinically Important Differences for the Peripheral Artery Disease Questionnaire. Circ Cardiovasc Qual Outcomes 2021; 14:e007232. [PMID: 33947205 DOI: 10.1161/circoutcomes.120.007232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding minimum clinically important differences (MCID) in patient-reported outcomes is essential in interpreting the magnitude of changes in these measures. No MCID from patients' perspectives has ever been published for peripheral artery disease-specific health status assessment tools. The Peripheral Artery Questionnaire (PAQ) is a commonly used, validated peripheral artery disease-specific health status instrument for which we sought to prospectively establish its MCID from patients' perspectives. METHODS AND RESULTS Patients presenting to vascular clinics with new or worsened claudication in the US cohort of the PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry who completed baseline and follow-up PAQ assessments along with the Global Assessment of Functioning scale were included. Mean change in PAQ summary scores from 3- to 6-month follow-up was calculated according to Global Assessment of Functioning category. MCID was defined as the mean difference in scores between those with small improvement or deterioration and those with no change. Multivariable linear regression was used to provide an MCID estimate after adjusting for patients' 3-month PAQ score. Of the 483 patients who completed the Global Assessment of Functioning score at 6 months and who had available 3- and 6-month PAQ assessments, the mean age was 69 years, 42% were female, and 71% were White. The MCIDs for PAQ summary scale improvement and worsening were 8.7 (2.9-14.5) and -11.0 (-18.6 to -3.3), respectively. After multivariable adjustment, these were 8.9 (3.0-14.8) and -11.2 (-18.2 to -4.2), respectively. There was no significant interaction between treatment (invasive versus noninvasive) and Global Assessment of Functioning response (P=0.75). CONCLUSIONS In patients with new or worsened claudication, a 10-point change in PAQ summary score represents an MCID. This estimate needs external validation and may inform the interpretation of PAQ scores when used as outcomes in clinical trials or in routine clinical care. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01419080.
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Affiliation(s)
- Poghni A Peri-Okonny
- Department of Internal Medicine, University of Missouri, Kansas City (P.A.P.-O., D.A., M.B., J.A.S.).,Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | - Jingyan Wang
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | | | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC (M.P.)
| | - Mehdi H Shishehbor
- Harrington Heart & Vascular Institute and Case Western University School of Medicine, Cleveland, OH (M.H.S.)
| | - David L Safley
- Department of Internal Medicine, University of Missouri, Kansas City (P.A.P.-O., D.A., M.B., J.A.S.).,Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Brown University, Providence, RI (J.D.A., H.D.A.)
| | - Herbert D Aronow
- Division of Cardiology, Department of Medicine, Brown University, Providence, RI (J.D.A., H.D.A.)
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (C.M.-H., Q.-U.-A.J., K.G.S.)
| | - Qurat-Ul-Ain Jelani
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (C.M.-H., Q.-U.-A.J., K.G.S.)
| | - Yuanyuan Tang
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | - Matthew Bunte
- Department of Internal Medicine, University of Missouri, Kansas City (P.A.P.-O., D.A., M.B., J.A.S.).,Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | | | - John F Beltrame
- Department of Medicine, Queen Elisabeth Hospital, Adelaide, Australia (C.L., J.F.B.)
| | - John A Spertus
- Department of Internal Medicine, University of Missouri, Kansas City (P.A.P.-O., D.A., M.B., J.A.S.).,Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (P.A.P.-O., J.W., J.G., D.S, Y.T., M.B., J.A.S.)
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (C.M.-H., Q.-U.-A.J., K.G.S.)
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Desai U, Kharat A, Hess CN, Milentijevic D, Laliberté F, Zuckerman P, Benson J, Lefebvre P, Hiatt WR, Bonaca MP. Incidence of Major Atherothrombotic Vascular Events among Patients with Peripheral Artery Disease after Revascularization. Ann Vasc Surg 2021; 75:217-226. [PMID: 33819600 DOI: 10.1016/j.avsg.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) treated with lower extremity revascularization are at increased risk of major atherothrombotic vascular events (acute limb ischemia (ALI), major non-traumatic lower-limb amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular (CV)-related death). This study assessed the incidence of major atherothrombotic vascular events, venous thromboembolism (VTE) events and rates of subsequent lower extremity revascularizations in the real-world among patients with PAD after revascularization. METHODS Patients aged ≥50 years with PAD who underwent peripheral revascularization were identified from Optum Clinformatics Data Mart claims database (Q1/2014-Q2/2019). The first lower extremity revascularization after PAD diagnosis was defined as index date. Incidence rates of major atherothrombotic vascular events (i.e., composite of ALI, major non-traumatic lower-limb amputation, MI, ischemic stroke, and CV-related death) and VTE were assessed during follow-up as the number of events divided by patient-years of observation (censored at the first event). Rates of subsequent revascularizations and VTE were estimated overall and compared between patients with major atherothrombotic vascular events and those without. RESULTS Of the 38,439 patients included, 6,675 (17.4%) had a major atherothrombotic vascular event during a median follow-up of 1.0 year. The composite major atherothrombotic vascular and VTE incidence rates were 13.81/100 patient years and 1.77/100 patient years, respectively, and 40.2% of patients experienced subsequent revascularizations. Patients with a post-revascularization major atherothrombotic vascular event had significantly higher rates of subsequent revascularizations (64.6% vs. 35.1%, standardized difference [SD] ≥10%) and VTE (4.6% vs. 2.1%, SD ≥10%) versus those without. CONCLUSION One-in-six PAD patients aged ≥50 years who underwent peripheral revascularization experienced a major atherothrombotic vascular event within one year, and consequently, experienced higher rates of subsequent revascularizations compared with those without a major atherothrombotic vascular event post-revascularization. These findings highlight the need to improve strategies to prevent major atherothrombotic vascular events after revascularization.
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Affiliation(s)
- Urvi Desai
- Analysis Group, Inc., Boston, Massachusetts.
| | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Connie N Hess
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
| | | | | | | | | | | | - William R Hiatt
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
| | - Marc P Bonaca
- University of Colorado School of Medicine, Division of Cardiology, Denver, Colorado; CPC Clinical Research, Aurora, Colorado
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9
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Desai U, Kharat A, Hess CN, Milentijevic D, Laliberté F, Zuckerman P, Benson J, Lefebvre P, Hiatt WR, Bonaca MP. Healthcare resource utilization and costs of major atherothrombotic vascular events among patients with peripheral artery disease after revascularization. J Med Econ 2021; 24:402-409. [PMID: 33634723 DOI: 10.1080/13696998.2021.1891089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Peripheral artery disease (PAD), often treated with lower extremity revascularization, is associated with risk of major atherothrombotic vascular events (acute limb ischemia [ALI], major non-traumatic lower-limb amputation, myocardial infarction [MI], ischemic stroke, cardiovascular death). This study aims to assess healthcare resource utilization and costs of such events among patients with PAD after revascularization. MATERIALS AND METHODS Patients aged ≥50 years with PAD who were treated with lower-extremity revascularization were identified from Optum Clinformatics Data Mart claims database (01/2014-06/2019). The first lower extremity revascularization after PAD diagnosis was defined as the index date. Patients had ≥6 months of health plan enrollment before the index date. Patients were followed until the earliest of 1) end of enrollment or data; 2) diagnosis of atrial fibrillation or venous thromboembolism; or 3) oral anticoagulant use. All-cause healthcare resource use per-patient-year was compared before and after a major atherothrombotic vascular event post-revascularization among those with an event. Additionally, event-related healthcare costs per-patient-year were reported for each event type. RESULTS Of the 38,439 PAD patients meeting the study criteria, 6,675 (17.4%) had a major atherothrombotic vascular event. On average, patients were observed for 7.3 months before an event and 6.2 months after an event. Patients with an event had significantly higher all-cause healthcare resource use versus similar metrics pre-event (e.g. inpatient visits among those with ALI: 3.5 ± 5.8 post-event vs. 2.0 ± 8.1 pre-event, p < .05). Event-related costs ranged from $57,825±$131,810 per-patient-year for ischemic stroke to $108,302±$150,168 for major non-traumatic lower-limb amputation. LIMITATIONS Data do not contain clinical information. Additionally, results are limited to commercially insured and Medicare Advantage beneficiaries. CONCLUSION Patients with PAD who experience major atherothrombotic vascular events post-revascularization have considerably higher healthcare resource use and costs compared with similar metrics pre-event. Therefore, reducing the rate of such events could reduce overall healthcare costs for this population.
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Affiliation(s)
| | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | | | | | | | | | | | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
| | - Marc P Bonaca
- Division of Cardiology, University of Colorado School of Medicine, Denver, CO, USA
- CPC Clinical Research, Aurora, CO, USA
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10
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Peri-Okonny PA, Patel S, Spertus JA, Jackson EA, Malik AO, Provance J, Mena-Hurtado C, Shishehbor MH, Hijjaji V, Gosch KL, Smolderen KG. Physical Activity After Treatment for Symptomatic Peripheral Artery Disease. Am J Cardiol 2021; 138:107-113. [PMID: 33065083 DOI: 10.1016/j.amjcard.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 02/01/2023]
Abstract
The association of invasive versus noninvasive treatment and physical activity level in patients with claudication remains unclear. Participants with claudication were enrolled from US vascular clinics. Treatment was categorized as invasive (surgical or endovascular treatment <3 months of initial visit) versus noninvasive. Self-reported leisure time (LTPA) and work related physical activity (WRPA) (sedentary, mild, moderate/strenuous), and health status (peripheral artery questionnaire summary score [PAQ SS]) was measured at baseline and 12 months. Change in PA was also categorized as increased, decreased, persistent sedentary [reference] and persistent active based on activity status at baseline and 12 months. Multivariable logistic regression assessed the association of treatment with 12-month LTPA and WRPA. Multivariable linear regression examined the association between 12-month change in PA with a 12-month change in PAQ. A total of 196of 656 patients (29.9%) underwent invasive treatment. There was no association between treatment and 12-month LTPA (p = 0.77) or WRPA (p = 0.26). Compared with being persistently sedentary, increased LTPA was associated with increased PAQ SS (OR 11.1 95% CI [4.4 to 17.7], p <0.01). In conclusion, there was no association between invasive treatment and physical activity at follow up despite a greater health status change in the invasive group. As increased physical activity was associated with more health status gains than remaining sedentary, additional ways to improve physical activity levels could potentially improve PAD outcomes.
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Affiliation(s)
- Poghni A Peri-Okonny
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
| | - Sarthak Patel
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Ali O Malik
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Jeremy Provance
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Carlos Mena-Hurtado
- Yale University School of Medicine, Vascular Medicine Outcomes lab, New Haven, Connecticut
| | - Mehdi H Shishehbor
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vittal Hijjaji
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kim G Smolderen
- Yale University School of Medicine, Vascular Medicine Outcomes lab, New Haven, Connecticut
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11
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Sasajima T, Sasajima Y, Akazawa K, Saito Y. Arterial Reconstruction for Patients with Chronic Limb Ischemia Improves Ambulatory Function and Health-related Quality of Life. Ann Vasc Surg 2020; 66:518-528. [PMID: 32035265 DOI: 10.1016/j.avsg.2020.01.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Arterial reconstruction (AR) for limb ischemia may improve ambulatory function (AF) and health-related quality of life (HR-QoL). However, the efficacy of AR in terms of HR-QoL varies in studies, probably because of cohort differences in disease severity, hemodynamic outcomes, and observation duration. We assessed HR-QoL for patients with various severities of ischemia in a 3-year observational study. METHODS We conducted a single-center 3-year observational study using Short Form 36 in patients with chronic limb ischemia. Between 2001 and 2009, 515 consecutive patients had AR, and 330 who underwent elective AR consented to the study. Of the 330 patients (claudicants 49%, critical limb ischemia [CLI] 51%), 307 underwent bypass and 23 endovascular therapy. Postal questionnaires were sent after AR, and 8 domains, the physical and mental component summary (PCS and MCS) scores, and the patient-reported AF were compared, and negative predictors were identified. RESULTS Overall, the MCS was minimally affected, but AF and the PCS were impaired. After AR, these measures were significantly improved, and maximum recovery was attained at 6 months. In subgroup analysis, significant predictors of a negative impact on postoperative PCS included age ≥80, CLI, physical aftereffects of stroke (PAS), and previous major amputation (PMA). Of these, PMA was associated with the lowest PCS score, followed by PAS; for these patients, AR contributed minimally to HR-QoL recovery. PCS scores of claudicants attained a maximum value at 6 months; however, PCS scores of CLI patients were significantly lower than intermittent claudication patients (P < 0.0001), and patients with major tissue loss required 2 years to attain maximum PCS recovery. CONCLUSIONS This 3-year observational study verified the efficacy of AR in improving AF and HR-QoL. Age ≥80, CLI, PAS, and PMA were definitive predictors, and for patients with the latter 2, AR contributed minimally to improving HR-QoL.
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Affiliation(s)
- Tadahiro Sasajima
- Center of Vascular Diseases, Edogawa Hospital, Tokyo, Japan; Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | - Yumi Sasajima
- Health Care Center, Hokkaido University of Education, Asahikawa College, Asahikawa, Japan
| | - Kohhei Akazawa
- Department of Medical Information, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yukihiro Saito
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
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12
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Jelani QUA, Jhamnani S, Spatz ES, Spertus J, Smolderen KG, Wang J, Desai NR, Jones P, Gosch K, Shah S, Attaran R, Mena-Hurtado C. Financial barriers in accessing medical care for peripheral artery disease are associated with delay of presentation and adverse health status outcomes in the United States. Vasc Med 2019; 25:13-24. [PMID: 31603393 DOI: 10.1177/1358863x19872542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-reported difficulties in affording health care and their association with health status outcomes in peripheral artery disease (PAD) have never been studied. We sought to determine whether financial barriers affected PAD symptoms at presentation, treatment patterns, and patient-reported health status in the year following presentation. A total of 797 United States (US) patients with PAD were identified from the Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) study, a prospective, multicenter registry of patients presenting to vascular specialty clinics with PAD. Financial barriers were defined as a composite of no insurance and underinsurance. Disease-specific health status was measured by Peripheral Artery Questionnaire (PAQ) and general health-related quality of life was measured by EuroQol 5 (EQ5D) dimensions at presentation and at 3, 6, and 12 months of follow-up. Among 797 US patients, 21% (n = 165) of patients reported financial barriers. Patients with financial barriers presented at an earlier age (64 ± 9.5 vs 70 ± 9.4 years), with longer duration of symptoms (59% vs 49%) (all p ⩽ 0.05), were more depressed and had higher levels of perceived stress and anxiety. After multivariable adjustment, health status was worse at presentation in patients with financial barriers (PAQ: -7.0 [-10.7, -3.4]; p < 0.001 and EQ5D: -9.2 [-12.74, -5.8]; p < 0.001) as well as through 12 months of follow-up (PAQ: -8.4 [-13.0, -3.8]; p < 0.001 and EQ5D: -9.7 [-13.2, -6.2]; p < 0.001). In conclusion, financial barriers are associated with later presentation as well as poorer health status at presentation and at 12 months. ClinicalTrials.gov Identifier: NCT01419080.
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Affiliation(s)
- Qurat-Ul-Ain Jelani
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sunny Jhamnani
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Erica S Spatz
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - John Spertus
- Department of Statistics, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,Biomedical & Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kim G Smolderen
- Department of Statistics, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.,Biomedical & Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jingyan Wang
- Department of Statistics, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Nihar R Desai
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Philip Jones
- Department of Statistics, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Kensey Gosch
- Department of Statistics, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Samit Shah
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Robert Attaran
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Department of Medicine, Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA
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13
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Petersohn S, Ramaekers BLT, Olie RH, Ten Cate-Hoek AJ, Daemen JWHC, Ten Cate H, Joore MA. Comparison of three generic quality-of-life metrics in peripheral arterial disease patients undergoing conservative and invasive treatments. Qual Life Res 2019; 28:2257-2279. [PMID: 30929124 PMCID: PMC6620242 DOI: 10.1007/s11136-019-02166-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine the effect of revascularisation for peripheral arterial disease (PAD) on QoL in the first and second year following diagnosis, to compare the effect depicted by Short Form Six Dimensions (SF-6D) and EuroQoL five Dimensions (EQ-5D) utilities, and Visual Analogue Scale (VAS) scores and to analyse heterogeneity in treatment response. METHODS Longitudinal data from 229 PAD patients were obtained in an observational study in southern Netherlands. Utility scores were calculated with the international (SF-6D) and Dutch (EQ-5D) tariffs. We analysed treatment effect at years 1 and 2 through propensity score-matched ANCOVAs. Thereby, we estimated the marginal means (EMMs) of revascularisation and conservative treatment, and identified covariates of revascularisation effect. RESULTS A year after diagnosis, 70 patients had been revascularised; the EMMs of revascularisation were 0.038, 0.077 and 0.019 for SF-6D, EQ-5D and VAS, respectively (always in this order). For conservative treatment these were - 0.017, 0.038 and 0.021. At 2-year follow-up, the EMMs of revascularisation were 0.015, 0.077 and 0.027, for conservative treatment these were - 0.020, 0.013 and - 0.004. Baseline QoL (and rest pain in year 2) were covariates of treatment effect. CONCLUSIONS We measured positive effects of revascularisation and conservative treatment on QoL a year after diagnosis, the effect of revascularisation was sustained over 2 years. The magnitude of effect varied between the metrics and was largest for the EQ-5D, which may be most suitable for QoL measurement in PAD patients. Baseline QoL influenced revascularisation effect, in clinical practice this may inform expected QoL gain in individual patients.
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Affiliation(s)
- Svenja Petersohn
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands.
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Renske H Olie
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Jan-Willem H C Daemen
- Department of Vascular surgery, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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14
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Peripheral Arterial Disease in Women: an Overview of Risk Factor Profile, Clinical Features, and Outcomes. Curr Atheroscler Rep 2018; 20:40. [PMID: 29858704 PMCID: PMC5984648 DOI: 10.1007/s11883-018-0742-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose of Review Peripheral arterial disease (PAD) is the third most common manifestation of cardiovascular disease (CVD), following coronary artery disease (CAD) and stroke. PAD remains underdiagnosed and under-treated in women. Recent Findings Women with PAD experience more atypical symptoms and poorer overall health status. The prevalence of PAD in women increases with age, such that more women than men have PAD after the age of 40 years. There is under-representation of PAD patients in clinical trials in general and women in particular. In this article, we address the lack of women participants in PAD trials. We then present a comprehensive overview of the epidemiology/risk factor profile, clinical features, treatment, and outcomes. Summary PAD is prevalent in women and its global burden is on the rise despite a decline in global age-standardized death rate from CVD. The importance of this issue has been underlined by the American Heart Association’s (AHA) “Call to Action” scientific statement on PAD in women. Large-scale campaigns are needed to increase awareness among physicians and the general public. Furthermore, effective treatment strategies must be implemented.
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15
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Bunte MC, Cohen DJ, Jaff MR, Gray WA, Magnuson EA, Li H, Feiring A, Cioppi M, Hibbard R, Gray B, Khatib Y, Jessup D, Patarca R, Du J, Stoll HP, Massaro J, Safley DM. Long-term clinical and quality of life outcomes after stenting of femoropopliteal artery stenosis: 3-year results from the STROLL study. Catheter Cardiovasc Interv 2018. [PMID: 29521013 DOI: 10.1002/ccd.27569] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To evaluate the clinical and health status outcomes of patients undergoing superficial femoral artery (SFA) revascularization using the Shape Memory Alloy Recoverable Technology (S.M.A.R.T.®) nitinol self-expanding stent through 3 years of follow-up. BACKGROUND Limited long-term data are available describing the durability of benefits after femoropopliteal revascularization. METHODS In a multicenter, prospective, core-lab adjudicated study, 250 subjects with de novo or restenotic femoropopliteal arterial lesions were treated with the S.M.A.R.T.® stent. The primary endpoint of target vessel patency, a composite of ultrasound-assessed patency and freedom from clinically driven target lesion revascularization (TLR), was evaluated through 3 years. Secondary endpoints included stent fracture and health status. Health status was measured using generic and disease-specific instruments, including the Peripheral Artery Questionnaire (PAQ). RESULTS At 3-year follow-up, Kaplan-Meier estimated target vessel patency was 72.7%, freedom from clinically driven TLR was 78.5%, and the incidence of stent fracture was 3.6%. The PAQ summary score was markedly impaired at baseline (mean 37.3 ± 19.6 points) and improved substantially at 1 month (mean change from baseline of 31.4 points, 95% CI: 28.5-34.3; P < 0.001). Disease-specific health status benefits assessed by the PAQ were largely preserved through 3 years of follow-up (mean change from baseline, 28.0 points, 95% CI: 24.3-31.7; P < 0.0001). CONCLUSIONS In patients undergoing revascularization for moderately complex SFA disease, use of the self-expanding S.M.A.R.T® stent was associated with a high rate of target vessel patency through 3 years and led to substantial and sustained health status benefits.
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Affiliation(s)
- Matthew C Bunte
- St Luke's Hospital and University of Missouri-Kansas City School of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- CardioVascular Institute, Division of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michael R Jaff
- Eifers Cardiovascular Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - William A Gray
- Main Line Health, Lankenau Heart Group, Wynnewood, Pennsylvania
| | - Elizabeth A Magnuson
- St Luke's Hospital and University of Missouri-Kansas City School of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Haiyan Li
- St Luke's Hospital and University of Missouri-Kansas City School of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Andrew Feiring
- Division of Cardiology, Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| | - Marco Cioppi
- Vascular Surgery Associates, P.C., Huntsville, Alabama
| | | | - Bruce Gray
- Department of Surgery, Vascular Medicine Division, Greenville Hospital, Greenville, South Carolina
| | - Yazan Khatib
- First Coast Cardiovascular Institute, Jacksonville, Florida
| | - David Jessup
- CarolinaEast Heart Center, New Bern, North Carolina
| | | | - Jing Du
- Cordis Clinical Research, Milpitas, California
| | | | - Joe Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts
| | - David M Safley
- St Luke's Hospital and University of Missouri-Kansas City School of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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16
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Zaitoun A, Al-Najafi S, Musa T, Szpunar S, Light D, Lalonde T, Yamasaki H, Mehta RH, Rosman HS. The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study. Vasc Med 2017; 22:498-504. [PMID: 28980511 DOI: 10.1177/1358863x17733065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = -6.6, p=0.05, 95% CI -13.2, -0.11).
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Affiliation(s)
- Anwar Zaitoun
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Saif Al-Najafi
- 2 Division of Cardiology, Rush University Hospital, Chicago, IL, USA
| | - Thaer Musa
- 3 Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Susan Szpunar
- 4 Department of Medical Education, St John Hospital and Medical Center, Detroit, MI, USA
| | - Dawn Light
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Thomas Lalonde
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | - Hiroshi Yamasaki
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
| | | | - Howard S Rosman
- 1 Division of Cardiology, St John Hospital and Medical Center, Detroit, MI, USA
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17
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Mays RJ, Regensteiner JG. Understanding sex differences in health status: A frontier in the field of vascular medicine. Vasc Med 2017; 22:110-111. [PMID: 28429661 DOI: 10.1177/1358863x17691625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ryan J Mays
- 1 Adult and Gerontological Health Cooperative, School of Nursing, Academic Health Center, University of Minnesota, Minneapolis, MN, USA.,2 Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,3 Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Judith G Regensteiner
- 2 Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,3 Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,4 Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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18
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Monaro S, West S, Gullick J. An integrative review of health-related quality of life in patients with critical limb ischaemia. J Clin Nurs 2017; 26:2826-2844. [PMID: 27808440 DOI: 10.1111/jocn.13623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the domains and the domain-specific characteristics within a peripheral arterial disease health-related quality of life framework for their usefulness in defining critical limb ischaemia health-related quality of life. BACKGROUND Critical Limb Ischaemia presents a highly individualised set of personal and health circumstances. Treatment options include conservative management, revascularisation or amputation. However, the links between treatment decisions and quality of life require further investigation. DESIGN The framework for this integrative review was the peripheral arterial disease-specific health-related quality of life domains identified by Treat-Jacobson et al. RESULTS The literature expanded and refined Treat-Jacobson's framework by modifying the characteristics to better describe health-related quality of life in critical limb ischaemia. CONCLUSIONS Given that critical limb ischaemia is a highly individualised situation with powerful health-related quality of life implications, further research focusing on patient and family-centred decision-making relating to therapeutic options and advanced care planning is required. RELEVANCE TO CLINICAL PRACTICE A critical limb ischaemia-specific, health-related quality of life tool is required to capture both the unique characteristics of this disorder, and the outcomes for active or conservative care among this complex group of patients.
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Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Concord, NSW, Australia.,Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Sandra West
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Janice Gullick
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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19
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Roumia M, Aronow HD, Soukas P, Gosch K, Smolderen KG, Spertus JA, Abbott JD. Sex differences in disease-specific health status measures in patients with symptomatic peripheral artery disease: Data from the PORTRAIT study. Vasc Med 2017; 22:103-109. [DOI: 10.1177/1358863x16686408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Mazen Roumia
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Herbert D Aronow
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter Soukas
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kensey Gosch
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Kim G Smolderen
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
- UMKC School of Medicine – Department of Biomedical & Health Informatics, Kansas City, MO, USA
| | - J Dawn Abbott
- Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA
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20
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Brostow DP, Petrik ML, Starosta AJ, Waldo SW. Depression in patients with peripheral arterial disease: A systematic review. Eur J Cardiovasc Nurs 2017; 16:181-193. [DOI: 10.1177/1474515116687222] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Megan L Petrik
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, USA
- Department of Medicine, University of Minnesota Medical School, USA
| | - Amy J Starosta
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Denver VA Medical Center, USA
- Department of Psychiatry, University of Colorado, USA
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21
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Garcia L, Jaff MR, Metzger C, Sedillo G, Pershad A, Zidar F, Patlola R, Wilkins RG, Espinoza A, Iskander A, Khammar GS, Khatib Y, Beasley R, Makam S, Kovach R, Kamat S, Leon LR, Eaves WB, Popma JJ, Mauri L, Donohoe D, Base CC, Rosenfield K. Wire-Interwoven Nitinol Stent Outcome in the Superficial Femoral and Proximal Popliteal Arteries: Twelve-Month Results of the SUPERB Trial. Circ Cardiovasc Interv 2016; 8:CIRCINTERVENTIONS.113.000937. [PMID: 25969545 DOI: 10.1161/circinterventions.113.000937] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent-based therapy in the superficial femoral and popliteal arteries in patients with peripheral artery disease is compromised by restenosis and risk of stent fracture or distortion. A novel self-expanding nitinol stent was developed that incorporates an interwoven-wire design (Supera stent, IDEV Technologies, Inc, Webster, TX) to confer greater radial strength, flexibility, and fracture resistance. METHODS AND RESULTS This prospective, multicenter, investigational device exemption, single-arm trial enrolled 264 patients with symptomatic peripheral artery disease undergoing percutaneous treatment of de novo or restenotic lesions of the superficial femoral or proximal popliteal (femoropopliteal) artery. Freedom from death, target lesion revascularization, or any amputation of the index limb at 30 days (+ 7 days) postprocedure was achieved in 99.2% (258/260) of patients (P < 0.001). Primary patency at 12 months (360 ± 30 days) was achieved in 78.9% (180/228) of the population (P < 0.001). Primary patency by Kaplan-Meier analysis at 12 months (360 days) was 86.3%. No stent fracture was observed by independent core laboratory analysis in the 243 stents (228 patients) evaluated at 12 months. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford-Becker category in 88.7% of patients. CONCLUSIONS The SUPERB Trial, an investigational device exemption study using an interwoven nitinol wire stent in the femoropopliteal artery, achieved the efficacy and safety performance goals predesignated by the Food and Drug Administration. On the basis of the high primary patency rate, absence of stent fracture, and significant improvements in functional and quality-of-life measures, the Supera stent provides safe and effective treatment of femoropopliteal lesions in symptomatic patients with peripheral artery disease. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00933270.
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Affiliation(s)
- Lawrence Garcia
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Michael R Jaff
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Christopher Metzger
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Gino Sedillo
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Ashish Pershad
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Frank Zidar
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Raghotham Patlola
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Robert G Wilkins
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Andrey Espinoza
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Ayman Iskander
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - George S Khammar
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Yazan Khatib
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Robert Beasley
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Satyaprakash Makam
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Richard Kovach
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Suraj Kamat
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Luis R Leon
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - William Britton Eaves
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Jeffrey J Popma
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Laura Mauri
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Dennis Donohoe
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Carol C Base
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.)
| | - Kenneth Rosenfield
- From the Division of Cardiology, St. Elizabeth Medical Center, Tufts University School of Medicine, Boston, MA (L.G.); Division of Cardiology, Massachusetts General Hospital, Boston (M.R.J., K.R.); Division of Cardiology, Wellmont Holston Valley Medical Center, Kingsport, TN (C.M.); CardioVascular Solutions Institute, Bradenton, FL (G.S.); Division of Cardiology, Banner Good Samaritan Medical Center, Phoenix, AZ (A.P.); Austin Heart, P.A., TX (F.Z.); Cardiovascular Institute of the South, Lafayette, LA (R.P.); Division of Cardiology, Hattiesburg Clinic, P.A., MS (R.G.W.); Hunterdon Cardiovascular Associates, P.A., Flemington, NJ (A.E.); St. Joseph's Hospital Cardiology Associates, Liverpool, NY (A.I.); Division of Cardiology, Plaza Medical Center of Fort Worth, TX (G.S.K.); First Coast Cardiovascular Institute, Jacksonville, FL (Y.K.); Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL (R.B.); Cardiovascular Research of Northwest Indiana, LLC, Munster, IN (S.M.); Division of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ (R.K.); Division of Cardiology, Alice Heart Center, TX (S.K.); Division of Cardiology, Tucson Medical Center, AZ (L.R.L.); Division of Cardiology, Willis Knighton Bossier Medical Center, Bossier City, LA (W.B.E.); Division of Cardiology, Beth Israel and Deaconess Medical Center, Boston, MA (J.J.P.); Division of Cardiology, Brigham and Women's Hospital and Harvard Clinical Research Institute, Boston, MA (L.M.); and IDEV Technologies, Inc, Webster, TX (D.D., C.C.B.).
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22
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Bunte MC, House JA, Spertus JA, Cohen DJ, Marso SP, Safley DM. Association between health status and long-term mortality after percutaneous revascularization of peripheral artery disease. Catheter Cardiovasc Interv 2016; 87:1149-55. [PMID: 26892836 DOI: 10.1002/ccd.26442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore the association of health status change and long-term survival among patients with symptomatic peripheral artery disease (PAD). BACKGROUND Early gains in health status after successful endovascular therapy (EVT) for symptomatic PAD can be maintained up to 1 year. Whether such health status improvements are associated with long-term survival benefits is unknown. METHODS Between February 2001 and August 2004, 258 patients with symptomatic PAD treated with EVT participated in a prospective study evaluating baseline and 1 year health status using the Peripheral Artery Questionnaire (range 0-100, higher scores = better). All-cause mortality was assessed for all patients at a median of 9.4 years following EVT. RESULTS The mean age at enrollment was 68 ± 11 years; 61% were male, 97% were Caucasian, and 38% had diabetes. Patients with a clinically meaningful health status improvement (≥8 points) 1 year after their index procedure (79%) were identified as responders. Responders had a significantly better 10 year survival compared with nonresponders (60% vs 38%, p = 0.025). Responder status was associated with a survival advantage that persisted in risk-adjusted analysis (adjusted hazard ratio for long-term mortality, 0.66 [95% CI, 0.45-0.97]; p = 0.036). CONCLUSIONS Among patients with symptomatic PAD undergoing EVT, improvement of PAD-specific health status at 1 year follow-up was associated with improved long-term survival. Whether additional treatment for patients with poor response to EVT could improve long-term survival warrants further investigation. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthew C Bunte
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - John A House
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Steven P Marso
- University of Texas-Southwestern Medical Center, Dallas, Texas
| | - David M Safley
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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23
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Abstract
Patient-reported outcomes (PROs) after vascular surgery are becoming increasingly important in the current era of health care reform. Although a number of general quality of life instruments exist, vascular disease-specific instruments may provide more targeted data on how patients feel after specific interventions. Here we provide a review of both generic and disease-specific instruments focused on arterial conditions, including peripheral arterial disease, carotid arterial disease, and aortic disease, which have been described in the literature. While many different tools currently exist, there is a paucity of well-validated, specific instruments that accurately reflect functional and objective measures of patients' arterial disease burden. A full understanding of the existing tools available to assess patients' perceived lifestyle impact of their disease and its treatments is essential for both research and clinical purposes, and to highlight the need for additional work on this topic.
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Affiliation(s)
- Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Ying Wei Lum
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287.
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One year health status benefits following treatment for new onset or exacerbation of peripheral arterial disease symptoms: the importance of patients' baseline health status. Eur J Vasc Endovasc Surg 2015; 50:213-22. [PMID: 26036809 DOI: 10.1016/j.ejvs.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 04/06/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE/BACKGROUND Limited information is available on expected health status gains following invasive treatment in peripheral arterial disease (PAD). One year health status outcomes following invasive treatment for PAD were compared, and whether pre-procedural health status was indicative of 1 year health status gains was evaluated. METHODS Pre-procedural and 1 year health status (Short Form-12, Physical Component Score [PCS]) was prospectively assessed in a cohort of 474 patients, enrolled from 2 Dutch vascular clinics (March 2006-August 2011), with new or exacerbation of PAD symptoms. One year treatment strategy (invasive vs. non-invasive) and clinical information was abstracted. Quartiles of baseline health status scores and mean 1 year health status change scores were compared by invasive treatment for PAD. The numbers needed to treat (NNT) to obtain clinically relevant changes in 1 year health status were calculated. A propensity weight adjusted linear regression analysis was constructed to predict 1 year PCS scores. RESULTS Invasive treatment was performed in 39% of patients. Patients with baseline health status scores in the lowest quartile undergoing invasive treatment had the greatest improvement (mean invasive 11.3 ± 10.3 vs. mean non-invasive 5.3 ± 8.5 [p = .001, NNT = 3]), whereas those in the highest quartile improved less (.8 ± 6.3 vs. -3.0 ± 8.2 [p = .025, NNT = 90]). Undergoing invasive treatment (p < .0001) and lower baseline health status scores (p < .0001) were independently associated with greater 1 year health status gains. CONCLUSION Substantial improvements were found in patients presenting with lower pre-procedural health status scores, whereas patients with higher starting health status levels had less to gain by an invasive strategy.
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25
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Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease. Int J Mol Sci 2015; 16:11355-68. [PMID: 25993299 PMCID: PMC4463704 DOI: 10.3390/ijms160511355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/14/2015] [Accepted: 01/29/2015] [Indexed: 11/17/2022] Open
Abstract
Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001). PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p's < 0.001). As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001). ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15). Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.
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Dreyer RP, van Zitteren M, Beltrame JF, Fitridge R, Denollet J, Vriens PW, Spertus JA, Smolderen KG. Gender differences in health status and adverse outcomes among patients with peripheral arterial disease. J Am Heart Assoc 2014; 4:e000863. [PMID: 25537275 PMCID: PMC4330046 DOI: 10.1161/jaha.114.000863] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have examined gender differences in health status and cardiovascular outcomes in patients with peripheral artery disease (PAD). This study assessed (1) self-reported health status at PAD diagnosis and 12-months later, and explored (2) whether outcomes in women with PAD differ with regard to long-term major adverse events. METHODS AND RESULTS A total of 816 patients (285 women) with PAD were enrolled from 2 vascular clinics in the Netherlands. Baseline clinical data and subsequent adverse events were recorded and patients completed the Short Form-12 (SF-12, Physical Component Score [PCS] and Mental Component Score [MCS]) upon PAD diagnosis and 12-months later. Women had similar ages and clinical characteristics, but poorer socio-economic status and more depressive symptoms at initial diagnosis, as compared with men. Women also had poorer physical (PCS: 37±10 versus 40±10, P=0.004) and mental ( MCS 47±12 versus 49±11, P=0.005) health status at the time of presentation. At 12-months, women still reported a poorer overall PCS score (41±12 versus 46±11, P=0.006) and MCS score (42±14 versus 49±12, P=0.002). Female gender was an independent determinant of a poorer baseline and 12-month PCS and MCS scores. However, there were no significant differences by gender on either mortality (unadjusted hazard ratio [HR]=0.93, 95% CI 0.60;1.44, P=0.74) or major adverse events (unadjusted HR=0.90, 95% CI 0.63;1.29, P=0.57), after a median follow-up of 3.2 years. CONCLUSIONS Women's physical and mental health status is compromised both at initial PAD diagnosis and at 12-month follow-up, despite experiencing a similar magnitude of change in their health scores throughout the first 12-months after diagnosis.
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Affiliation(s)
- Rachel P Dreyer
- Center for Outcomes Research and Evaluation (CORE), New Haven, CT (R.P.D.) Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.P.D.)
| | - Moniek van Zitteren
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (M.Z., J.D.) Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (M.Z., P.W.V.)
| | - John F Beltrame
- Discipline of Medicine, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia (J.F.B.)
| | - Robert Fitridge
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia (R.F.)
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands (M.Z., J.D.)
| | - Patrick W Vriens
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands (M.Z., P.W.V.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.G.S.) UMKC-University of Missouri-Kansas City, Kansas City, MO (J.A.S., K.G.S.)
| | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S., K.G.S.) UMKC-University of Missouri-Kansas City, Kansas City, MO (J.A.S., K.G.S.)
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Reynolds MR, Apruzzese P, Galper BZ, Murphy TP, Hirsch AT, Cutlip DE, Mohler ER, Regensteiner JG, Cohen DJ. Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial. J Am Heart Assoc 2014; 3:e001233. [PMID: 25389284 PMCID: PMC4338709 DOI: 10.1161/jaha.114.001233] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both supervised exercise (SE) and stenting (ST) improve functional status, symptoms, and quality of life compared with optimal medical care (OMC) in patients with claudication. The relative cost-effectiveness of these strategies is not well defined. METHODS AND RESULTS The Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) study randomized patients with claudication due to aortoiliac stenosis to a 6-month SE program, to ST, or to OMC. Participants who completed 6-month follow-up (n=98) were included in a health economic analysis through 18 months. Costs were assessed using resource-based methods and hospital billing data. Quality-adjusted life-years were estimated using the EQ-5D. Markov modeling based on the in-trial results was used to explore the impact of assumptions about the longer term durability of observed differences in quality of life. Through 18 months, mean healthcare costs were $5178, $9804, and $14 590 per patient for OMC, SE, and ST, respectively. Measured quality-adjusted life-years through 18 months were 1.04, 1.16, and 1.20. In our base case analysis, which assumed that observed differences in quality of life would dissipate after 5 years, the incremental cost-effectiveness ratios were $24 070 per quality-adjusted life-year gained for SE versus OMC, $41 376 for ST versus OMC, and $122 600 for ST versus SE. If the treatment effect of ST was assumed to be more durable than that of SE, the incremental cost-effectiveness ratio for ST versus SE became more favorable. CONCLUSIONS Both SE and ST are economically attractive by US standards relative to OMC for the treatment of claudication in patients with aortoiliac disease. ST is more expensive than SE, with uncertain incremental benefit. CLINICAL TRIAL REGISTRATION URL www.clinicaltrials.gov, Unique identifier: NCT00132743.
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Affiliation(s)
| | | | | | | | | | | | - Emile R. Mohler
- Division of Cardiovascular Disease, Section of Vascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (E.R.M.)
| | | | - David J. Cohen
- Saint‐Luke's Mid America Heart Institute, University of Missouri‐Kansas City School of Medicine, Kansas City, MO (D.J.C.)
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van Zitteren M, Vriens PW, Burger DH, de Fijter WM, Gerritsen GP, Heyligers JM, Nooren MJ, Smolderen KG. Determinants of invasive treatment in lower extremity peripheral arterial disease. J Vasc Surg 2014; 59:400-408.e2. [PMID: 24461863 DOI: 10.1016/j.jvs.2013.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 05/18/2013] [Accepted: 08/25/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Since it is unknown what factors are weighed in a clinician's decision to refer patients with symptomatic lower extremity peripheral arterial disease (PAD) for invasive treatment, we examined the relationship between health status, lesion location, and site variations and invasive treatment referral ≤1 year following diagnosis in patients with PAD. METHODS This was a prospective observational cohort study on ambulatory patients that presented themselves at two vascular surgery outpatient clinics. A total of 970 patients with new symptoms of PAD or with an exacerbation of existing PAD symptoms that required clinical evaluation and treatment (Rutherford Grade I) were eligible, 884 consented and were included between March 2006 and November 2010. We report on 505 patients in the current study. Prior to patients' initial PAD evaluation, the Short Form-12, Physical Component Scale (PCS) was administered to measure health status. Anatomical lesion location (proximal vs distal) was derived from duplex ultrasounds. PCS scores, lesion location, and site were evaluated as determinants of receiving invasive (endovascular, surgery) vs noninvasive treatment ≤1 year following diagnosis in Poisson regression analyses, adjusting for demographics, ankle-brachial index, and risk factors. RESULTS Invasive treatment as a first-choice was offered to 167 (33%) patients. While an association between poorer health status and invasive therapy was found in unadjusted analyses (relative risk [RR], 0.98; 95% confidence interval [CI], 0.97-1.00; P = .011), proximal lesion location (RR, 3.66; 95% CI, 2.70-4.96; P < .0001) and site (RR, 1.69; 95% CI, 1.11-2.58; P = .014) were independent predictors of invasive treatment referral in the final model. CONCLUSIONS One-third of patients were treated invasively following PAD diagnosis. Patients' health status was considered in providers' decision to refer patients for invasive treatment, but having a proximal lesion was the strongest predictor. This study also found some important first indications of site variations in offering invasive treatment among patients with PAD. Future work is needed to further document these variations in care.
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Affiliation(s)
- Moniek van Zitteren
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Patrick W Vriens
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Desiree H Burger
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - W Marnix de Fijter
- Department of Vascular Surgery, TweeSteden Hospital, Tilburg, The Netherlands
| | - G Pieter Gerritsen
- Department of Vascular Surgery, TweeSteden Hospital, Tilburg, The Netherlands
| | - Jan M Heyligers
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Maria J Nooren
- Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Kim G Smolderen
- Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Saint Luke's Mid-America Heart Institute, Kansas City, Mo.
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Armstrong EJ. Commentary: nitinol stents for femoropopliteal disease: what is the view from the SUMMIT? J Endovasc Ther 2013; 20:767-9. [PMID: 24325692 DOI: 10.1583/13-4430c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, University of Colorado, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
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Murphy TP, Reynolds MR, Cohen DJ, Regensteiner JG, Massaro JM, Cutlip DE, Mohler ER, Cerezo J, Oldenburg NC, Thum CC, Goldberg S, Hirsch AT. Correlation of patient-reported symptom outcomes and treadmill test outcomes after treatment for aortoiliac claudication. J Vasc Interv Radiol 2013; 24:1427-35; quiz 1436. [PMID: 23906799 PMCID: PMC4724411 DOI: 10.1016/j.jvir.2013.05.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To examine the relationship between objective treadmill test outcomes and subjective symptom outcomes among patients with claudication treated with stent revascularization (ST) compared with supervised exercise (SE). MATERIALS AND METHODS Five scales of the Peripheral Artery Questionnaire and Walking Impairment Questionnaire were correlated with peak walking time and treadmill claudication onset time. RESULTS The correlation between change in disease-specific quality of life (QOL) and change in peak walking time differed according to treatment group, with statistically significant correlations for all five scales for the ST group and weaker trends for the SE group, only one of which was statistically significant. In contrast, improvements in disease-specific QOL correlated well with increases in claudication onset time, with no significant interaction with treatment group for any of the five scales. CONCLUSIONS Disease-specific QOL results at 6 months in the Claudication: Exercise Vs. Endoluminal Revascularization (CLEVER) study show that improved maximal treadmill walking in patients with claudication treated with SE correlated poorly with self-reported symptom relief. Conversely, patients treated with ST showed good correlation between improved maximal treadmill walking and self-reported symptom improvement. The correlation between claudication onset time and self-reported symptom relief was good across treatment groups. This finding indicates that traditional objective treadmill test outcomes may not correlate well with symptom relief in patients with claudication. Future studies should investigate these data and improve understanding of patient relevance of traditional objective treadmill-based treatment outcomes.
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Affiliation(s)
- Timothy P Murphy
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy Street, Providence, RI 02903.
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Kinlay S. Outcomes for clinical studies assessing drug and revascularization therapies for claudication and critical limb ischemia in peripheral artery disease. Circulation 2013; 127:1241-50. [PMID: 23509032 PMCID: PMC4507406 DOI: 10.1161/circulationaha.112.001232] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Scott Kinlay
- MBBS, Cardiovascular Division, VA Boston Healthcare System, 1400 VFW Pkwy, West Roxbury, MA 02132, USA.
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Lee JH, Cho KI, Spertus J, Kim SM. Cross-cultural adaptation and validation of the Peripheral Artery Questionnaire: Korean version for patients with peripheral vascular diseases. Vasc Med 2012; 17:215-22. [PMID: 22653880 DOI: 10.1177/1358863x12445104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Peripheral Artery Questionnaire (PAQ), as developed in US English, is a validated scale to evaluate the health status of patients with peripheral artery disease (PAD). The aim of this study was to translate the PAQ into Korean and to evaluate its reliability and validity. A multi-step process of forward-translation, reconciliation, consultation with the developer, back-translation and proofreading was conducted. The test-retest reliability was evaluated at a 2-week interval using the intra-class correlation coefficient (ICC). The validity was assessed by identifying associations between Korean PAQ (KPAQ) scores and Korean Health Assessment Questionnaire (KHAQ) scores. A total of 100 PAD patients were enrolled: 63 without and 37 with severe claudication. The reliability of the KPAQ was adequate, with an ICC of 0.71. There were strong correlations between KPAQ's subscales. Cronbach's alpha for the summary score was 0.94, indicating good internal consistency and congruence with the original US version. The validity was supported by a significant correlation between the total KHAQ score and KPAQ physical function, stability, symptom, social limitation and quality of life scores (r = -0.24 to -0.90; p < 0.001) as well as between the KHAQ walking subscale and the KPAQ physical function score (r = -0.55, p < 0.001). Our results indicate that the KPAQ is a reliable, valid instrument to evaluate the health status of Korean patients with PAD.
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Affiliation(s)
- Ji Hyun Lee
- 1Division of Rheumatology, Maryknoll Medical Center, Busan, Republic of Korea
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Mastenbroek M, Hoeks S, Pedersen S, Scholte op Reimer W, Voute M, Verhagen H. Gender Disparities in Disease-specific Health Status in Postoperative Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2012; 43:433-40. [DOI: 10.1016/j.ejvs.2011.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Murphy TP, Cutlip DE, Regensteiner JG, Mohler ER, Cohen DJ, Reynolds MR, Massaro JM, Lewis BA, Cerezo J, Oldenburg NC, Thum CC, Goldberg S, Jaff MR, Steffes MW, Comerota AJ, Ehrman J, Treat-Jacobson D, Walsh ME, Collins T, Badenhop DT, Bronas U, Hirsch AT. Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study. Circulation 2011; 125:130-9. [PMID: 22090168 DOI: 10.1161/circulationaha.111.075770] [Citation(s) in RCA: 305] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Claudication is a common and disabling symptom of peripheral artery disease that can be treated with medication, supervised exercise (SE), or stent revascularization (ST). METHODS AND RESULTS We randomly assigned 111 patients with aortoiliac peripheral artery disease to receive 1 of 3 treatments: optimal medical care (OMC), OMC plus SE, or OMC plus ST. The primary end point was the change in peak walking time on a graded treadmill test at 6 months compared with baseline. Secondary end points included free-living step activity, quality of life with the Walking Impairment Questionnaire, Peripheral Artery Questionnaire, Medical Outcomes Study 12-Item Short Form, and cardiovascular risk factors. At the 6-month follow-up, change in peak walking time (the primary end point) was greatest for SE, intermediate for ST, and least with OMC (mean change versus baseline, 5.8±4.6, 3.7±4.9, and 1.2±2.6 minutes, respectively; P<0.001 for the comparison of SE versus OMC, P=0.02 for ST versus OMC, and P=0.04 for SE versus ST). Although disease-specific quality of life as assessed by the Walking Impairment Questionnaire and Peripheral Artery Questionnaire also improved with both SE and ST compared with OMC, for most scales, the extent of improvement was greater with ST than SE. Free-living step activity increased more with ST than with either SE or OMC alone (114±274 versus 73±139 versus -6±109 steps per hour), but these differences were not statistically significant. CONCLUSIONS SE results in superior treadmill walking performance than ST, even for those with aortoiliac peripheral artery disease. The contrast between better walking performance for SE and better patient-reported quality of life for ST warrants further study. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/ct/show/NCT00132743?order=1. Unique identifier: NCT00132743.
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Affiliation(s)
- Timothy P Murphy
- Vascular Disease Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy St, Providence, RI 02903, USA.
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Prevalence and Predictors of Persistent Health Status Impairment in Patients Referred to a Vascular Clinic with Intermittent Claudication. Eur J Vasc Endovasc Surg 2011; 42:355-62. [DOI: 10.1016/j.ejvs.2011.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 02/07/2011] [Indexed: 11/20/2022]
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Smolderen KG, Safley DM, House JA, Spertus JA, Marso SP. Percutaneous transluminal angioplasty: Association between depressive symptoms and diminished health status benefits. Vasc Med 2011; 16:260-6. [DOI: 10.1177/1358863x11415568] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depressive symptoms are known to compromise health status in cardiac disease, but this relationship has not been described in peripheral artery disease (PAD). Depressive symptoms (PHQ-9) and disease-specific health status (Peripheral Artery Questionnaire, PAQ) were assessed in 242 PAD patients undergoing percutaneous transluminal angioplasty (PTA) at baseline and 1 year. Patients were classified by baseline and follow-up depression status (moderate–severe depressive symptoms = PHQ ≥ 10). Changes were categorized as no depression/improvement of depression versus persistent/worsened depression. At baseline, 20% of patients were depressed; at 1 year, 17% of patients experienced persistent/worsened depression. Although this group improved on most PAQ subscales, they improved to a significantly lesser degree than those without depressive symptoms or those who improved by 1 year ( p-values < 0.05). Baseline depressive symptoms (Bper 5-point increment = −11.9, 95% CI −15.3, −8.5, p < 0.0001) and changes in depression were independently associated with a decrease in 1-year health status (Bper 5-point increment = −11.7, 95% CI −14.3, −9.2, p < 0.0001). In conclusion, depressive symptoms are associated with less improvement in health status 1 year after undergoing a peripheral endovascular revascularization (PER) as compared with those having no depression or whose depressive symptoms improve. Efforts to improve depression detection and treatment among patients with PAD may improve the health status outcomes of these patients.
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Affiliation(s)
- Kim G Smolderen
- Saint Luke’s Mid America Heart and Vascular Institute, Kansas City, MO, USA
- Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
| | - David M Safley
- Saint Luke’s Mid America Heart and Vascular Institute, Kansas City, MO, USA
- University of Missouri Kansas City, Kansas City, MO, USA
| | - John A House
- Saint Luke’s Mid America Heart and Vascular Institute, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart and Vascular Institute, Kansas City, MO, USA
- University of Missouri Kansas City, Kansas City, MO, USA
| | - Steven P Marso
- Saint Luke’s Mid America Heart and Vascular Institute, Kansas City, MO, USA
- University of Missouri Kansas City, Kansas City, MO, USA
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Mays RJ, Casserly IP, Kohrt WM, Ho PM, Hiatt WR, Nehler MR, Regensteiner JG. Assessment of functional status and quality of life in claudication. J Vasc Surg 2011; 53:1410-21. [PMID: 21334172 DOI: 10.1016/j.jvs.2010.11.092] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Treadmill walking is commonly used to evaluate walking impairment and efficacy of treatment for intermittent claudication (IC) in clinical and research settings. Although this is an important measure, it does not provide information about how patients perceive the effects of their treatments on more global measures of health-related quality of life (HRQOL). METHODS PubMed/Medline was searched to find publications about the most commonly used questionnaires to assess functional status and/or general and disease-specific HRQOL in patients with peripheral artery disease (PAD) who experience IC. Inclusion criteria for questionnaires were based on existence of a body of literature in symptomatic PAD. RESULTS Six general questionnaires and seven disease-specific questionnaires are included, with details about the number of domains covered and how each tool is scored. The Medical Outcomes Study Short Form 36-item questionnaire and Walking Impairment Questionnaire are currently the most used general and disease-specific questionnaires at baseline and after treatment for IC, respectively. CONCLUSIONS The use of tools that assess functional status and HRQOL has importance in both the clinical and research areas to assess treatment efficacy from the patient's perspective. Therefore, assessing HRQOL in addition to treadmill-measured walking ability provides insight as to the effects of treatments on patient outcomes and may help guide therapy.
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Affiliation(s)
- Ryan J Mays
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
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Dyer MTD, Goldsmith KA, Sharples LS, Buxton MJ. A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 2010; 8:13. [PMID: 20109189 PMCID: PMC2824714 DOI: 10.1186/1477-7525-8-13] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/28/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. METHODS A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. RESULTS Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. CONCLUSIONS The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.
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Affiliation(s)
- Matthew TD Dyer
- Health Economics Research Group, Brunel University, Uxbridge, UK
- National Collaborating Centre for Mental Health, The Royal College of Psychiatrists, London, UK
| | - Kimberley A Goldsmith
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Linda S Sharples
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Martin J Buxton
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Smolderen KG, Pelle AJ, Kupper N, Mols F, Denollet J. Impact of peripheral arterial disease on health status: a comparison with chronic heart failure. J Vasc Surg 2009; 50:1391-8. [PMID: 19958988 DOI: 10.1016/j.jvs.2009.07.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/27/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To further document the experienced burden in patients with peripheral arterial disease (PAD), we compared the health status of patients with PAD and chronic heart failure (CHF). As a secondary aim, we studied clinical and socio-demographic correlates of health status in both conditions. METHODS We conducted a cross-sectional observational study in four outpatient clinics in the Southern part of The Netherlands, with subjects consisting of ambulatory (346 PAD and 188 CHF) patients. All patients completed the Short-Form 12 to assess their physical and mental health status. Information about socio-demographic, clinical risk factors, and disease severity indices was obtained from patients' medical records. Propensity methodology was applied to enhance comparability between both medical conditions. RESULTS Type of medical condition explained differences in health status (F = 33.1, P < .0001, Effect Size = 0.27). Impaired physical health status was more often reported in PAD patients (48.4%) compared with CHF patients (17.4%, Odds Ratio [OR] = 4.4, 95% Confidence Interval [CI] 2.3-8.8, P < .0001); impaired mental health status was more noted in CHF patients (43.5% vs. 22.0%, OR = 1.7, 95% CI 1.2-2.6, P = .002). In PAD, younger age (P = .002), low education (P = .02), cardiac history (P = .02), diabetes mellitus (P = .03), and a lower ankle brachial index (P = .003) were associated with worse physical health status; younger age (P = .01) and living without partner (P = .01) were associated with lower mental health status scores. In CHF, patients with comorbid diabetes mellitus (P < .001) and females (P = .001) reported worse physical health, whereas no clinical or socio-demographics were associated with mental health status. CONCLUSIONS By contrasting PAD patients' health status with another chronic disabling condition, the impact of PAD on patients' physical health status became evident; whereas mental health status was more affected in CHF, patients with PAD reported a greater physical burden as compared with CHF patients. PAD patients who were younger, lower-educated, without a partner or had a cardiac history especially reported a higher disease burden. Clinicians need to be aware of these differences in order to develop tailor-made disease management programs for different groups of cardiovascular patients.
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Affiliation(s)
- Kim G Smolderen
- Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
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Preoperative cardiac risk index predicts long-term mortality and health status. Am J Med 2009; 122:559-65. [PMID: 19376487 DOI: 10.1016/j.amjmed.2008.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/06/2008] [Accepted: 10/10/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Peripheral arterial disease patients undergoing vascular surgery are known to be at risk for the occurrence of (late) cardiovascular events. Before surgery, the perioperative cardiac risk is commonly assessed using the Lee Risk Index score, a combination of 6 cardiac risk factors. This study assessed the predictive value of the Lee Risk Index for late mortality and long-term health status in patients after vascular surgery. METHODS Between May and December 2004, data on 711 consecutive peripheral arterial disease patients undergoing vascular surgery were collected from 11 hospitals in the Netherlands. Before surgery, the Lee Risk Index was assessed in all patients. At 3-year follow-up, 149 patients died (21%) and the disease-specific Peripheral Artery Questionnaire (PAQ) was completed in 84% (n=465) of the survivors. Impaired health status according to the PAQ was defined by the lowest tertile of the PAQ summary score. Multivariable regression analyses were performed to investigate the prognostic ability of the Lee Index for mortality and impaired health status at 3-year follow-up. RESULTS The Lee Risk Index proved to be an independent prognostic factor for both late mortality (1 risk factor hazard ratio (HR)=2.1; 95% confidence interval [CI], 1.2-3.6; 2 risk factors HR=2.4; 95% CI, 1.4-4.0 and >or=3 risk factors HR=3.2; 95% CI, 1.7-6.2) and impaired health status at 3-year follow-up (1 risk factor odds ratio [OR]=2.0; 95% CI, 1.1-3.5; 2 risk factors OR=2.9; 95% CI, 1.6-5.2 and >or=3 risk factors OR=3.2; 95% CI, 1.3-7.5). The predominant contributing factors associated with late mortality were cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency. For impaired health status, ischemic heart disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and renal insufficiency were the prognostic factors. CONCLUSIONS The preoperative Lee Risk Index is not only an important prognostic factor for in-hospital outcome but also for late mortality and impaired health status in patients with peripheral arterial disease.
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Hoeks SE, Smolderen KG, Scholte Op Reimer WJM, Verhagen HJM, Spertus JA, Poldermans D. Clinical validity of a disease-specific health status questionnaire: the peripheral artery questionnaire. J Vasc Surg 2008; 49:371-7. [PMID: 19028064 DOI: 10.1016/j.jvs.2008.08.089] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 08/25/2008] [Accepted: 08/26/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Measuring patient-centered outcomes is becoming increasingly important in patients with peripheral arterial disease (PAD), both as a means of determining the benefits of treatment and as an aid for disease management. In order to monitor health status in a reliable and sensitive way, the disease-specific measure Peripheral Artery Questionnaire (PAQ) was developed. However, to date, its correlation with traditional clinical indices is unknown. The primary aim of this study was to better establish the clinical validity of the PAQ by examining its association with functional indices related to PAD. Furthermore, we hypothesized that the clinical validity of this disease-specific measure is better as compared with the EuroQol-5-dimensional (EQ-5D), a standardized generic instrument. METHODS Data on 711 consecutive PAD patients undergoing surgery were collected from 11 Dutch hospitals in 2004. At 3-year follow-up, questionnaires including the PAQ, EQ-5D, and EuroQol-Visual Analogue Scale (EQ VAS) were completed in 84% of survivors. The PAQ was analyzed according to three domains, as established by a factor analyses in the Dutch population, and the summary score. Baseline clinical indices included the presence and severity of claudication intermittent (CI) and the Lee Cardiac Risk Index. RESULTS All three PAQ domains (Physical Function, Perceived Disability, and Treatment Satisfaction) were significantly associated with CI symptoms (P values < .001-.008). Patients with claudication had significant lower PAQ summary scores as compared with asymptomatic patients (58.6 +/- 27.8 vs 68.6 +/- 27.8, P = < .001). Furthermore, the PAQ summary score and the subscale scores for Physical Functioning and Perceived Disability demonstrated a clear dose-response relation for walking distance and the Lee Risk Index (P values < .001-.031). With respect to the generic EQ-5D, the summary EQ-5D index was associated with CI (0.81 +/- 0.20 vs 0.76 +/- 0.24, P = .031) but not with walking distance (P = .128) nor the Lee Risk Index (P = .154). The EQ VAS discriminated between the clinical indices (P values = .003-.008), although a clear dose-response relation was lacking. CONCLUSION The clinical validity of the PAQ proved to be good as the PAQ subscales discriminated well between patients with or without symptomatic PAD and its severity as defined by walking distance. Furthermore, the PAQ subscales were directly proportional to the presence and number of risk factors relevant for PAD. For studying outcomes in PAD patients, the disease-specific PAQ is likely to be a more sensitive measure of treatment benefit as compared with the generic EQ VAS, although the latter may still be of value when comparing health status across different diseases. Regarding disease management, we advocate the use of the disease-specific PAQ as its greater sensitivity and validity will assist its translation into clinical practice.
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Affiliation(s)
- Sanne E Hoeks
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Smolderen K, Hoeks S, Aquarius A, Scholte op Reimer W, Spertus J, van Urk H, Denollet J, Poldermans D. Further Validation of the Peripheral Artery Questionnaire: Results from a Peripheral Vascular Surgery Survey in the Netherlands. Eur J Vasc Endovasc Surg 2008; 36:582-91. [DOI: 10.1016/j.ejvs.2008.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 07/24/2008] [Indexed: 10/21/2022]
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Lozano F. Calidad de vida relacionada con la cirugía vascular. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mahmud E, Cavendish JJ, Salami A. Current Treatment of Peripheral Arterial Disease. J Am Coll Cardiol 2007; 50:473-90. [PMID: 17678729 DOI: 10.1016/j.jacc.2007.03.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 03/12/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Despite advances in medical therapies to help prevent the development of atherosclerosis and improve the management of patients with established peripheral arterial disease (PAD), the prevalence of PAD and associated morbidity remains high. Over the past decade, percutaneous revascularization therapies for the treatment of patients with PAD have evolved tremendously, and a great number of patients can now be offered treatment options that are less invasive than traditional surgical options. With the surgical approach, there is significant symptomatic improvement, but the associated morbidity and mortality preclude its routine use. Although newer percutaneous treatment options are associated with lower procedural complications, the technical advances have outpaced the evaluation of these treatments in adequately designed clinical studies, and therapeutic options are available that may not have been rigorously investigated. Therefore, for physicians treating patients with PAD, an understanding of the various therapies available, along with the inherent benefits and limitations of each treatment option is imperative as a greater number of patients with PAD are being encountered.
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Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California, San Diego School of Medicine, San Diego, California 92103-8784, USA.
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