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Felix CMDM, Pereira DAG, Pakosh M, da Silva LP, Ghisi GLDM. A Scoping Review of Measurement Tools Evaluating Awareness and Disease-Related Knowledge in Peripheral Arterial Disease Patients. J Clin Med 2023; 13:107. [PMID: 38202114 PMCID: PMC10780123 DOI: 10.3390/jcm13010107] [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: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible. The objective of this scoping review was: (1) to identify and critically appraise instruments that measure patients' disease-related knowledge/awareness about PAD, and (2) to characterize the current state of knowledge/awareness levels among these patients. METHODS This systematic review was conducted and reported in accordance with the PRISMA statement. Six databases (APA PsycInfo, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL and Web of Science Core Collection) were searched, and search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. RESULTS The initial database search yielded 9832 records, of which sixteen studies (thirteen quantitative and three qualitative) were included. Only three questionnaires had their psychometric properties assessed. Questionnaire items focused on the following topics: definition/characteristics, risk factors/causes, treatment, complications, and personal issues regarding the perception/management of the disease. Overall, knowledge/awareness about PAD was low among patients. CONCLUSIONS This study identified major gaps in PAD education, including the lack of availability of a validated measurement tool addressing all educational topics relevant to care and low knowledge/awareness of patients about their condition.
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Affiliation(s)
- Carolina Machado de Melo Felix
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Danielle Aparecida Gomes Pereira
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
| | - Lilian Pinto da Silva
- Graduate Program in Rehabilitation Sciences and Physical Functional Performance, Faculty of Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Gabriela Lima de Melo Ghisi
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- KITE Research Institute, University Health Network, Toronto, ON M4G 1R7, Canada
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Alsheikh S, Altoijry A, Alokayli S, Alkhalife SI, Alsahil SJ, AlGhofili H. Exploring Understanding of Peripheral Artery Disease among Patients at High-Risk in Saudi Arabia: Results from an Interview-Based Study. Clin Pract 2023; 14:13-23. [PMID: 38391398 PMCID: PMC10887943 DOI: 10.3390/clinpract14010002] [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: 10/21/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The level of awareness of peripheral artery disease (PAD) in Saudi Arabia, especially among populations at high risk, is not currently well known. Therefore, our objective was to assess the existing level of awareness among patients who are at high risk of PAD, as well as their comprehension of the disease. METHOD An interview-based cross-sectional study included 1035 participants with risk factors for PAD and collected data on demographics and knowledge domains related to PAD. RESULTS The statistical analysis was performed using t-tests and ANOVA. Overall, participants exhibited poor knowledge, with a mean score of 5.7 out of 26. The highest scores were observed in the risk factor and preventive measure domains, with means of 1.8 out of 7 and 1.8 out of 6, respectively. The factors associated with higher knowledge scores included older age, male gender, higher education, healthcare profession, interviews in vascular settings, previous awareness of PAD, and prior cardio-cerebrovascular interventions. CONCLUSION This study underscores the inadequate knowledge of PAD among high-risk individuals. Targeted educational initiatives are essential to bridge this knowledge gap, potentially reducing the burden of PAD-related complications and improving patient outcomes. Efforts should focus on raising awareness about PAD, particularly among high-risk populations.
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Affiliation(s)
- Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Shirin Alokayli
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Sarah Ibrahim Alkhalife
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Shahad Jamal Alsahil
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Hesham AlGhofili
- Vascular Surgery Department, King Salman Heart Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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Foley MP, Tubassam M, Walsh SR. An audit of secondary prevention for peripheral arterial disease in primary care - scope for improved collaboration between vascular surgery and general practitioners. Ir J Med Sci 2023; 192:3007-3010. [PMID: 37099256 PMCID: PMC10692140 DOI: 10.1007/s11845-023-03362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Symptomatic peripheral arterial disease (PAD) is a common cause for referral from primary care to vascular surgery. Best medical therapy (BMT), encompassing anti-platelets, statins, smoking cessation, blood pressure and glycaemic control, is a cornerstone of PAD management. However, these easily modifiable risk factors are often left unaddressed between referral and clinic review. METHODS A prospective audit of electronic 'Healthlink' referrals by GPs to the vascular department for symptomatic PAD between July 2021 and June 2022 was performed. Referrals were individually reviewed for demographics, symptoms, medical history, smoking status and medications. An information leaflet on BMT was posted to all GP practices in the Soalta region as part of an educational intervention, with plans to re-audit after 6 months. RESULTS One-hundred-and-seventy referrals were analysed. The median age was 68.5 years (range 33-94) and 69% (n = 117) were male. The typical vasculopath comorbidity profile was noted. Fifty-two percent (n = 88) were referred with claudication-type pain and 25% (n = 43) with critical limb ischaemia (CLI). Twenty-eight percent (n = 33) were active smokers and 31% (n = 36) had no smoking status documented. Regarding BMT, only 34.5% (n = 40) and 52% (n = 60) were on anti-platelets and statins, respectively. Suspected CLI was not significantly associated with BMT prescription at referral (p = 0.664). Only eleven referral letters mentioned risk factor optimisation. CONCLUSIONS Our first-cycle results identified significant scope for improvement in community-based risk factor modification for PAD referrals. We aim to continue supporting and educating our colleagues that effective medical management can start safely in primary care and further explore the barriers preventing this.
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Affiliation(s)
- Megan Power Foley
- Department of Vascular Surgery, University College Hospital Galway, Newcastle Road, Dublin 8, Dublin, H91YR71, Ireland.
| | - Muhammad Tubassam
- Department of Vascular Surgery, University College Hospital Galway, Newcastle Road, Dublin 8, Dublin, H91YR71, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Stewart R Walsh
- Department of Vascular Surgery, University College Hospital Galway, Newcastle Road, Dublin 8, Dublin, H91YR71, Ireland
- School of Medicine, University of Galway, Galway, Ireland
- National Surgical Research Support Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Striberger R, Zarrouk M, Kumlien C, Axelsson M. Illness perception, health literacy, self-efficacy, adherence and quality of life in patients with intermittent claudication - a longitudinal cohort study. BMC Nurs 2023; 22:167. [PMID: 37198627 DOI: 10.1186/s12912-023-01329-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Patients with intermittent claudication need lifelong treatment with secondary prevention to prevent cardiovascular events and progression of atherosclerotic disease. Illness perception, health literacy, self-efficacy, adherence to medication treatment, and quality of life are factors influencing patients' self-management. Knowledge of these factors could be important when planning for secondary prevention in patients with intermittent claudication. AIM to compare illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life in in patients with intermittent claudication. METHODS A longitudinal cohort study was conducted with 128 participants recruited from vascular units in southern Sweden. Data were collected through medical records and questionnaires regarding illness perception, health literacy, self-efficacy, adherence to treatment, and quality of life. RESULTS In the subscales in illness perception, patients with sufficient health literacy reported less consequences and lower emotional representations of the intermittent claudication. They also reported higher self-efficacy and higher quality of life than patients with insufficient health literacy. In comparison between men and women in illness perception, women reported higher illness coherence and emotional representations associated with intermittent claudication compared to men. A multiple regression showed that both consequences and adherence were negative predictors of quality of life. When examining changes over time, a significant increase in quality of life was seen between baseline and 12 months, but there were no significant differences in self-efficacy.. CONCLUSION Illness perception differs in relation to level of health literacy and between men and women. Further, the level of health literacy seems to be of importance for patients' self-efficacy and quality of life. This illuminates the need for new strategies for improving health literacy, illness perception, and self-efficacy over time. For example, more tailored information regarding secondary prevention could be provided to strengthen self-management to further improve quality of life in patients with intermittent claudication.
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Affiliation(s)
- Rebecka Striberger
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, SE-20506, Sweden.
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
| | - Moncef Zarrouk
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, SE-20506, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, SE-20506, Sweden
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Horváth L, Németh N, Fehér G, Kívés Z, Endrei D, Boncz I. Epidemiology of Peripheral Artery Disease: Narrative Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071041. [PMID: 35888129 PMCID: PMC9320565 DOI: 10.3390/life12071041] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022]
Abstract
Past decades have witnessed a major epidemiologic transition with a considerable increase in the disease burden associated with atherosclerotic cardiovascular diseases (CVDs), with low-income and middle-income countries (LMICs) experiencing substantial increase in CVDs. As the global population is aging and peripheral artery disease (PAD) is strongly age-related, it is estimated to become increasingly prevalent in the future. PAD shares risk factors with coronary and cerebrovascular risk factors, particularly diabetes mellitus and smoking, and is associated with significant CVD morbidity and mortality. Despite advances in therapeutic modalities, 236 million people were estimated to be suffering from PAD worldwide in 2015, and numbers have been rising since. The prevalence of asymptomatic PAD has remained high; PAD prevalence seems higher among women and is related to ethnicity. Although several epidemiological studies have been published on PAD during the past decades, data from LMICs are scarce. Besides providing up-to-date epidemiological data retrieved from the literature and the Global Burden of Disease (GBD) study database, this narrative review also intends to draw attention to the substantial disease burden of PAD manifesting in more Years of Life Lost (YLL), age-adjusted mortality and amputation rates, with a special focus on some European countries and especially Hungary, i.e., the country with the highest amputation rate in Europe.
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Affiliation(s)
- Lilla Horváth
- Centre for Occupational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Doctoral School, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
- Correspondence:
| | - Noémi Németh
- Doctoral School, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Gergely Fehér
- Centre for Occupational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary;
- Department of Primary Health Care, University of Pécs, 7623 Pécs, Hungary
| | - Zsuzsanna Kívés
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (Z.K.); (D.E.); (I.B.)
| | - Dóra Endrei
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (Z.K.); (D.E.); (I.B.)
- 1st Department of Internal Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (Z.K.); (D.E.); (I.B.)
- National Laboratory for Human Reproduction, University of Pécs, 7624 Pécs, Hungary
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Goodney P, Shah S, Hu YD, Suckow B, Kinlay S, Armstrong DG, Geraghty P, Patterson M, Menard M, Patel MR, Conte MS. A systematic review of patient-reported outcome measures patients with chronic limb-threatening ischemia. J Vasc Surg 2022; 75:1762-1775. [PMID: 35085747 PMCID: PMC9524582 DOI: 10.1016/j.jvs.2021.11.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/08/2021] [Indexed: 01/23/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) causes significant morbidity with profound negative effects on health-related quality of life. As the prevalence of peripheral artery disease and diabetes continue to rise in our aging population, the public health impact of CLTI has escalated. Patient-reported outcome measures (PROMs) have become common and important measures for clinical evaluation in both clinical care and research. PROMs are important for the measurement of clinical effectiveness and cost effectiveness and for shared decision-making on treatment options. However, the PROMs used to describe the experience of patients with CLTI are heterogeneous, incomplete, and lack specific applicability to the underlying disease processes and diverse populations. For example, certain PROMs exist for patients with extremity wounds, and other PROMs exist for patients with pain, and still others exist for patients with vascular disease. Despite this multiplicity of tools, no single PROM encompasses all of the components necessary to describe the experiences of patients with CLTI. This significant unmet need is evident from both published reports and contemporary large-scale clinical trials in the field. In this systematic review, we review the current use of PROMs for patients with CLTI in clinical practice and in research trials and highlight the gaps that need to be addressed to develop a unifying PROM instrument for CLTI.
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Affiliation(s)
- Philip Goodney
- Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
| | - Samir Shah
- Vascular Surgery, University of Florida, Gainesville, Fla
| | - Yiyuan David Hu
- Geisel School of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Bjoern Suckow
- Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Scott Kinlay
- Cardiovascular Medicine, Boston Medical Center, Boston, Mass
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Patrick Geraghty
- Vascular Surgery, Washington University in St. Louis, St. Louis, Mo
| | | | - Matthew Menard
- Vascular Surgery, Brigham and Women's Hospital, Boston, Mass
| | | | - Michael S Conte
- Vascular Surgery, University of California, San Francisco, San Francisco, Calif
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Keelan S, Foley N, Healy D, Kheirelseid E, McHugh S, Moneley D, Naughton P. Poor patient awareness of peripheral arterial disease, it is time to optimize the clinical visit. Surgeon 2021; 20:157-163. [PMID: 34148771 DOI: 10.1016/j.surge.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is a growing public health burden. The development and progression of PAD is influenced by vascular risk factor management and lifestyle changes. However, public awareness of PAD is low compared with other conditions such as heart disease and stroke, which have been the subject of widespread public health campaigns. This study aimed to determine current levels of PAD awareness among hospital patients. METHODS This cross-sectional, tertiary hospital-based, descriptive study was conducted over 6 months in 2019. Two investigators administered the survey in face-to-face interviews to patients attending 3 different hospital-based settings including vascular clinics (VC), cardiology clinics (CVC), and Emergency Department (ED). RESULTS A total of 150 patients were interviewed. Participants demonstrated low overall awareness of vascular disease (32% PAD and 21% AAA) compared to cardiovascular disease including stroke (71%) and myocardial infarction (63%). Awareness of PAD was higher in vascular patients (51%) compared to CVC and ED patients (p=<0.01). Of the total population, 77% and 71% identified the contributory role of smoking and limited exercise to the development of PAD respectively. VC patients were more informed of intermittent claudication (78%) and amputation (80%) (p < 0.01) compared to CVC and ED patients. CONCLUSION In the global drive to reduce vascular morbidity, this study highlights the poor knowledge of PAD among the public. In addition, there is poor awareness about the incidence, risk factors and complications of PAD. These results highlight the need for accessible and easily understood information regarding PAD in both the clinic setting and public health campaigns.
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Affiliation(s)
- Stephen Keelan
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland.
| | - Niamh Foley
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Donagh Healy
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | | | - Seamus McHugh
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Peter Naughton
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
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Gresele P, Guglielmini G, Del Pinto M, Calabrò P, Pignatelli P, Patti G, Pengo V, Antonucci E, Cirillo P, Fierro T, Palareti G, Marcucci R. Peripheral arterial disease has a strong impact on cardiovascular outcome in patients with acute coronary syndromes: from the START Antiplatelet registry. Int J Cardiol 2020; 327:176-182. [PMID: 33152418 DOI: 10.1016/j.ijcard.2020.10.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) was reported to increase the risk of new cardiovascular events in patients with acute coronary syndromes (ACS). However, most of the evidence comes from randomized clinical trials. We aimed to assess the impact of PAD on cardiovascular outcome and treatment decisions in ACS patients in a current real-life setting. METHODS START-ANTIPLATELET is a multicenter registry enrolling ACS patient. Baseline clinical characteristics and treatment at discharge were recorded and follow-up was repeated at 6-months and 1-year. PAD was defined as intermittent claudication and/or previous revascularization. RESULTS Among 1442 patients enrolled, 103 (7.1%) had PAD. PAD patients were older (71.8 ± 10.6vs66.2 ± 12.6 yrs., p < 0.0001), more frequently hypertensive (90.3vs68.6%, p< 0.0001), hypercholesterolemic (66vs52%, p= 0.037), diabetic (51.5vs24%, p= 0.0001), obese (28.2vs19.3%, p= 0.029) and with previous TIA (7.8vs2.8%, p= 0.005) or stroke (11.7vs3.1%, p< 0.0001). Clinical presentation and acute treatment were similar in non-PAD and PAD patients, but the latter were discharged significantly less frequently on dual antiplatelet therapy (DAPT) (68.9vs85%, p= 0.005). After a median follow-up time of 11.1 months, major cardio/cerebrovascular event-free survival [MACCE, including cardiovascular death, MI, TIA and stroke, target-vessel revascularization (TVR) and major arterial ischemic events] was significantly shorter (9.0vs11.2 months, p= 0.02; HR 3.2, 2.4-8.4) in PAD patients and net adverse cardiovascular events (NACE = MACCE plus major hemorrhages) were significantly more frequent (19.1%vs10.5%, p = 0.049). CONCLUSIONS PAD identifies a subgroup of ACS patients at significantly increased cardiovascular risk, but these patients tend to be undertreated. Patients admitted for ACS should be screened for PAD and optimal medical therapy at discharge should be implemented.
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Affiliation(s)
- P Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
| | - G Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - M Del Pinto
- Division of Cardiology, Perugia Hospital, Italy
| | - P Calabrò
- Department of Translational Medical Sciences University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P Pignatelli
- Department of Clinical, Internistic, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - G Patti
- Department of Traslational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - V Pengo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| | - E Antonucci
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - P Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - T Fierro
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - G Palareti
- Arianna Anticoagulazione Foundation, Bologna, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy
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Illness perceptions in patients with peripheral arterial disease: A systematic review of qualitative studies. Int J Nurs Stud 2020; 116:103723. [PMID: 32826079 DOI: 10.1016/j.ijnurstu.2020.103723] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/24/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with chronic diseases create their own subjective beliefs about their conditions based on their illness perceptions. In the common-sense model, illness perceptions constitute personal beliefs about illness with regard to five components: identity, timeline, cause, control/cure, and consequences. Patients' illness perceptions affect both their management of their disease and their adherence to treatment. Since patients with peripheral arterial disease need life-long treatment for secondary prevention, generating knowledge about illness perceptions in patients with peripheral arterial disease is essential. OBJECTIVES To systematically review and synthesise the literature on illness perceptions in patients with peripheral arterial disease. DESIGN A systematic review DATA SOURCES: PubMed, CINAHL, and PsycINFO. REVIEW METHODS A systematic search strategy was conducted in December 2017, with an update in July 2019. Two team members independently screened all titles and abstracts. A relevance and quality appraisal of the studies was performed. The references from the included studies were evaluated for additional studies. The data from 14 studies were extracted and synthesised using a "best-fit" approach to framework analysis. A deductive analysis was conducted using the common-sense model. The data not suitable for the framework were analysed separately using inductive conventional content analysis, yielding an additional component representing the retrospective consequences of peripheral arterial disease. FINDINGS The findings showed diversity in illness perceptions in each of the five components of the framework as well as in the additional component. The findings showed participants' lack of understanding of the chronic nature of the disease, i.e., about the timeline, the identity of the symptoms and the cause of the disease. The patients' beliefs about control and cures varied from having high motivation to engage in physical activity to thinking that walking could make their situations worse. There was fear about the future, as patients perceived disease progression and decreasing control to be consequences of their illness. Living with the disease, the emphasis in the additional component, was a process for regaining control and adapting to their situations. CONCLUSIONS Patients with peripheral arterial disease shape their own understandings of their conditions. These beliefs may influence their management of their disease and adherence to treatment. Therefore, the current study suggests that illness perceptions should be addressed when planning secondary prevention for patients with peripheral arterial disease.
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Trends and outcomes of non-traumatic major lower extremity amputations in an Irish tertiary referral hospital. Ir J Med Sci 2020; 189:1351-1358. [PMID: 32323085 DOI: 10.1007/s11845-020-02231-5] [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: 02/28/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation outcomes among vascular patients in Ireland following lower extremity amputation (LEA), and compare subgroups of those undergoing transfemoral (TFA) or transtibial amputation (TTA). METHODS A review was conducted of all patients who underwent non-traumatic TFA or TTA from 2000 to 2009 in a tertiary vascular surgery centre. Demographics, surgical data, perioperative outcomes, medium-term functional outcomes, and survival were assessed. RESULTS One hundred and seventy-two patients (2:1 male: female) underwent 192 non-traumatic LEAs. Median age for TFA was 75 years and TTA 67 (p = 0.002). A percentage of 36.5% had undergone prior attempts at surgical revascularization, 25% had undergone prior distal amputation or debridement. Thirty-three (17%) required stump revision. Twenty-three (13.2%) died in hospital. Median survival for those who died in hospital was 17 days (0-367), versus 17 months (2-106) for those who survived to discharge. CONCLUSION LEA for vascular pathology has significant morbidity and mortality, with long in-patient stays and short median survival; there is need to focus on improving quality of life in postoperative pathways.
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11
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Bridgwood BM, Nickinson ATO, Houghton JSM, Pepper CJ, Sayers RD. Knowledge of peripheral artery disease: What do the public, healthcare practitioners, and trainees know? Vasc Med 2020; 25:263-273. [DOI: 10.1177/1358863x19893003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This systematic review evaluated the knowledge and awareness of peripheral artery disease (PAD) within the general public (including patients with peripheral vascular disease), nonspecialist healthcare professionals (nsHCP), and trainees (medical students and trainee doctors). Relevant articles were identified from electronic databases using key search terms: ‘peripheral artery disease’; ‘limb ischaemia’; ‘intermittent claudication’; ‘knowledge’; ‘understanding’; ‘public’; ‘medical professional’. The heterogeneous results were described narratively. A lack of knowledge and understanding of PAD (disease awareness) were identified in all groups. Among nsHCPs, factors which affect knowledge include the level of training, early clinical exposure and the presence of family members with cardiovascular/vascular disease. Within the general public, knowledge and awareness was improved if a family member/friend had a diagnosis, or following a patient-centred consultation with any HCP. Public campaigns are proven effective in improving disease knowledge/awareness in conditions such as stroke alongside sustained patient education. These may provide future avenues to improve PAD knowledge and awareness, in order to effectively manage risk factors and minimise delayed or missed diagnosis of PAD. (PROSPERO registration number: CRD42018117304)
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Affiliation(s)
| | - Andrew TO Nickinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - John SM Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Coral J Pepper
- Library and Information Services, University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | - Rob D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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A systematic review investigating the identification, causes, and outcomes of delays in the management of chronic limb-threatening ischemia and diabetic foot ulceration. J Vasc Surg 2019; 71:669-681.e2. [PMID: 31676182 DOI: 10.1016/j.jvs.2019.08.229] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Patients presenting with chronic limb-threatening ischemia and diabetic foot ulceration (DFU) are at high risk of major lower limb amputation. Long-standing concern exists regarding late presentation and delayed management contributing to increased amputation rates. Despite multiple guidelines existing on the management of both conditions, there is currently no accepted time frame in which to enact specialist care and treatment. This systematic review aimed to investigate potential time delays in the identification, referral, and management of both chronic limb-threatening ischemia and DFU. METHODS A systematic review conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards was performed searching MEDLINE, Embase, The Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature from inception to November 14, 2018. All English-language qualitative and quantitative articles investigating or reporting the identification, causes, and outcomes of time delays within "high-income" countries (annual gross domestic product per person >$15,000) were included. Data were extracted independently by the investigators. Given the clinical crossover, both conditions were investigated together. A study protocol was designed and registered at the International Prospective Register of Systematic Reviews. RESULTS A total of 4780 articles were screened, of which 32 articles, involving 71,310 patients and 1388 health care professionals, were included. Twenty-three articles focused predominantly on DFU. Considerable heterogeneity was noted, and only 12 articles were deemed of high quality. Only four articles defined a delay, but this was not consistent between studies. Median times from symptom onset to specialist health care assessment ranged from 15 to 126 days, with subsequent median times from assessment to treatment ranging from 1 to 91 days. A number of patient and health care factors were consistently reported as potentially causative, including poor symptom recognition by the patient, inaccurate health care assessment, and difficulties in accessing specialist services. Twenty articles reported outcomes of delays, namely, rates of major amputation, ulcer healing, and all-cause mortality. Although results were heterogeneous, they allude to delays being associated with detrimental outcomes for patients. CONCLUSIONS Time delays exist in all aspects of the management pathway, which are in some cases considerable in length. The causes of these are complex but reflect poor patient health-seeking behaviors, inaccurate health care assessment, and barriers to referral and treatment within the care pathway. The adoption of standardized limits for referral and treatment times, exploration of missed opportunities for diagnosis, and investigation of novel strategies for providing specialist care are required to help reduce delays.
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Builyte IU, Baltrunas T, Butkute E, Srinanthalogen R, Skrebunas A, Urbonavicius S, Rucinskas K. Peripheral artery disease patients are poorly aware of their disease. SCAND CARDIOVASC J 2019; 53:373-378. [DOI: 10.1080/14017431.2019.1645350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Tomas Baltrunas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Reconstructive Vascular and Endovascular Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Egle Butkute
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Reshaabi Srinanthalogen
- Department of Vascular Surgery, Cardiovascular Research Unit, Hospitalsenhed Midt, Viborg, Denmark
| | - Arminas Skrebunas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Reconstructive Vascular and Endovascular Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sigitas Urbonavicius
- Department of Vascular Surgery, Cardiovascular Research Unit, Hospitalsenhed Midt, Viborg, Denmark
| | - Kestutis Rucinskas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Heart and Chest Surgery, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
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Sutton M, Kreider K, Thompson J, Germanwala S, Greifenkamp J. Improving outcomes in patients with peripheral arterial disease. JOURNAL OF VASCULAR NURSING 2018; 36:166-172. [DOI: 10.1016/j.jvn.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
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15
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Weragoda J, Weerasinghe MC, Seneviratne R, Wijeyaratne SM. Gaps in awareness of peripheral arterial disease in Sri Lanka: a cross sectional study. BMC Public Health 2016; 16:1073. [PMID: 27729055 PMCID: PMC5059915 DOI: 10.1186/s12889-016-3748-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/06/2016] [Indexed: 11/22/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is an emerging problem in Sri Lanka, particularly with the ageing population. A considerable number of patients are detected at a late stage with severe limb ischemia or chronic non-healing leg ulceration. Public awareness about PAD is important in developing preventive strategies. Methods A cross sectional study was conducted to assess awareness of PAD among adults aged 40–74 years in a district in Sri Lanka. In total, 2912 adults were selected for the study using a multistage probability proportionate to size sampling technique. Data were collected by an interviewer-administered questionnaire. Participants who were aware of PAD were asked about common risk factors, possible consequences of untreated PAD, and sources of information. Multivariate logistic regression analysis was used to assess the independent predictors of PAD awareness. Results We found that 4.1 % of participants were aware of PAD (95 % confidence interval: 3.4–4.8), which was significantly lower than awareness of other cardiovascular diseases such as cerebrovascular accidents (67.3 %) and myocardial infarction (57.6 %) (p < 0.001). Being male, an urban resident, and having a higher level of education were independent predictors of high PAD awareness. Conclusions Our findings suggest that a comprehensive PAD awareness program that covers risk factors, consequences, and preventative strategies is needed to enhance public awareness of PAD.
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Affiliation(s)
- Janaka Weragoda
- Public Health Complex, 6th Floor, 555/5, Ministry of Health, Elvitigala Mawatha, Narahenpita, Colombo, 10100, Sri Lanka.
| | - Manuj C Weerasinghe
- Department of Community Medicine, Faculty of Medicine, University of Colombo, No.25, Kynsey Road, Colombo, 008000, Sri Lanka
| | - Rohini Seneviratne
- Department of Community Medicine, Faculty of Medicine, University of Colombo, No.25, Kynsey Road, Colombo, 008000, Sri Lanka
| | - S M Wijeyaratne
- Department of Surgery, Faculty of Medicine, University of Colombo, No.25, Kynsey Road, Colombo, 00800, Sri Lanka
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Coughlin PA. Commentary on "Male Sex Associated With Increased Long-term Cardiovascular Mortality After Peripheral Vascular Surgery for Atherosclerosis Despite Optimal Medical Treatment". Eur J Vasc Endovasc Surg 2015; 50:774. [PMID: 26433595 DOI: 10.1016/j.ejvs.2015.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/28/2015] [Indexed: 11/28/2022]
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Chakfe N, Lejay A. Commentary on 'peripheral artery disease: a marked lack of awareness in Ireland'. Eur J Vasc Endovasc Surg 2015; 49:563-4. [PMID: 25747174 DOI: 10.1016/j.ejvs.2015.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- N Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - A Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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