One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease-Reference-Cited by-同舟云学术

One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease

Published:2022-06 Issue:6 Volume:15 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Angraal Suveen¹,Hejjaji Vittal²^ORCID,Tang Yuanyuan³,Gosch Kensey L.³^ORCID,Patel Manesh R.⁴^ORCID,Heyligers Jan⁵,White Christopher J.⁶,Tutein Nolthenius Rudolf⁷,Mena-Hurtado Carlos⁸^ORCID,Aronow Herbert D.⁹^ORCID,Moneta Gregory L.¹⁰,Fitridge Robert¹¹,Soukas Peter A.¹²,Abbott J. Dawn¹²^ORCID,Secemsky Eric A.¹³¹⁴^ORCID,Spertus John A.²^ORCID,Smolderen Kim G.⁸^ORCID

Affiliation:

1. Department of Internal Medicine, University of Missouri Kansas City School of Medicine (S.A.).

2. Department of Cardiology, Saint Luke’s Mid America Heart Institute (V.H., J.A.S.), University of Missouri-Kansas City.

3. Saint Luke’s Mid America Heart Institute, Kansas City, MO (Y.T., K.L.G.).

4. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.R.P.).

5. Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands (J.H.).

6. Department of Cardiology, Ochsner Clinical School, University of Queensland, AU, and Ochsner Health, New Orleans, LA (C.J.W.).

7. Department of (vascular) Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands (R.T.N.).

8. Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (C.M.-H., K.G.S.).

9. Division of Cardiology, Lifespan Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI (H.D.A.).

10. Division of Vascular Surgery, Department of Surgery and Knight Cardiovascular Institute, Oregon Health & Science University, Portland (H.D.A., G.L.M.).

11. Departments of Vascular Surgery, Royal Adelaide and The Queen Elizabeth Hospital, Australia (R.F.).

12. Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI (P.A.S., J.D.A.).

13. Division of Cardiology (E.A.S.), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

14. Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (E.A.S.), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

Abstract

Background: Lifestyle changes and medications are recommended as the first line of treatment for claudication, with revascularization considered for treatment-resistant symptoms, based on patients’ preferences. Real-world evidence comparing health status outcomes of early invasive with noninvasive management strategies is lacking. Methods: In the international multicenter prospective observational PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry, disease-specific health status was assessed by the Peripheral Artery Questionnaire in patients with new-onset or worsening claudication at presentation and 3, 6, and 12 months later. One-year health status trajectories were compared by early revascularization versus noninvasive management on a propensity-matched sample using hierarchical generalized linear models for repeated measures adjusted for baseline health status. Results: In a propensity-matched sample of 1000 patients (67.4±9.3 years, 62.8% male, and 82.4% White), 297 (29.7%) underwent early revascularization and 703 (70.3%) were managed noninvasively. Over 1 year of follow-up, patients who underwent early invasive management reported significantly higher health status than patients managed noninvasively (interaction term for time and treatment strategy; P <0.001 for all Peripheral Artery Questionnaire domains). The average 1-year change in Peripheral Artery Questionnaire summary scores was 30.8±25.2 in those undergoing early invasive, compared with 16.7±23.4 in those treated noninvasively ( P <0.001). Conclusions: Patients with claudication undergoing early invasive treatment had greater health status improvements over the course of 1 year than those treated noninvasively. These data can be used to support shared decision-making with patients. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01419080.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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