Patient profiles and health status outcomes for peripheral artery disease in high-income countries: a comparison between the USA and The Netherlands

Author:

Jelani Qurat-Ul-Ain1ORCID,Smolderen Kim G1,Halpin David2,Gosch Kensey3,Spertus John A34,Iyad Ochoa Chaar Cassius5,Tutein Nolthenius Rudolf P6,Heyligers Jan78,De Vries Jean-Paul9,Mena-Hurtado Carlos1

Affiliation:

1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 20 York St, New Haven 06520, CT, USA

2. David Halpin: Colorado Heart and Vascular Institute, 030 Mountain View Ave, Ste 300. Longmont, Colorado 80501, USA

3. Saint Luke’s Mid America Heart Institute/UMKC, 4401 Wornall Rd, Kansas Kansas City, MO 64111, USA

4. University of Missouri-Kansas City, 5000 Holmes St., Kansas City, MO 64110, USA

5. Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 20 YorK Street, New Haven, CT 06520, USA

6. Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands

7. Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands

8. Department of Surgery, St Elisabeth Hospital, Hilvarenbeekse Weg 60, 5022 GC Tilburg, The Netherlands

9. Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

Abstract

Abstract Aims Peripheral artery disease (PAD) is a global disease. Understanding variability in patient profiles and PAD-specific health status outcomes across health system countries can provide insights into improving PAD care. We compared these features between two high-income countries, the USA and The Netherlands. Methods and results Patients were identified from the patient-centred outcomes related to treatment practices in peripheral arterial disease: investigating trajectories study—a prospective, international registry of patients presenting to vascular specialty clinics for new onset, or exacerbation of PAD symptoms. PAD-specific health status was measured with the peripheral artery questionnaire. General linear mixed models for repeated measures were used to study baseline, 3, 6, and 12-month PAD-specific health status outcomes (peripheral artery questionnaire summary score) between the USA and The Netherlands. Out of a total of 1114 patients, 748 patients (67.1%) were from the USA and 366 (32.9%) from The Netherlands. US patients with PAD were older, with more financial barriers, higher cardiovascular risk factor burden, and lower referral rates for exercise treatment (P < 0.001). They had significantly worse PAD-specific adjusted health status scores at presentation, 3, 6, and 12 months of follow-up (all P < 0.0001). Magnitude of change in 1-year health status scores was smaller in the US cohort when compared with The Netherlands. Conclusion Compared with the Dutch cohort, US patients had worse adjusted PAD-specific health status scores at all time point, improving less over time, despite treatment. Leveraging inter-country differences in care and outcomes could provide important insights into optimizing PAD outcomes. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01419080? term=portrait&rank=1 NCT01419080.

Funder

A Patient-Centered Outcomes Research Institute

The Netherlands Organization for Scientific Research

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Health Policy

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