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Cerrud-Rodriguez RC, Romain G, Hussain Y, Cleman J, Callegari S, Scierka L, Smolderen KG, Mena-Hurtado C. Impact of early intervention on health status outcomes in peripheral artery disease patients with chronic total occlusion lesions using the PORTRAIT registry. J Vasc Surg 2024; 80:780-790.e10. [PMID: 38735596 DOI: 10.1016/j.jvs.2024.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To analyze the impact of noninvasive and early invasive treatments on health status in patients with lower extremity peripheral arterial disease (PAD) without and with chronic total occlusions (CTOs) after 12 months of follow-up. METHODS Using the international (the United States, the Netherlands, and Australia) observational longitudinal Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories registry, we included patients with recent PAD symptoms between June 2011 and December 2015. We assessed the PAD-specific health status at initial visit and the 3-, 6-, and 12-month follow-up using the Peripheral Arterial Questionnaire. On a propensity matched-weighted cohort, we compared patients' characteristics by CTO status and treatment groups as early invasive (revascularization in the 3 months) vs noninvasive (exercise, medical therapies, or smoking cessation). We then assessed the health status trajectory over 12 months, as a three-way interaction between CTO status, treatment groups, and months, using a multilevel generalized linear regression model for repeated measures adjusted for baseline health status with random effects at the site and patient levels. RESULTS We included 581 participants, with a mean age of 66.62 ± 9.33 years, 34.3% female, and 90.8% White, of whom 353 (60.8%) were without and 228 (39.2%) had a CTO lesion. Respectively, 96 (27.2%) and 70 (30.7%) patients underwent early invasive treatment (d = 0.07). Although patients with CTO were more likely to have lower resting ABI, multilevel disease, and to experience severe claudication vs their counterparts (|d| ≥ 0.20), patient health status at baseline with CTO was not different from those without CTO, with mean summary scores of 45.14 ± 20.26 vs 45.90 ± 21.24 (d = 0.04), respectively. The trajectory did not differ by CTO status (interaction CTO status × month; P = .517) and was higher in early invasive vs noninvasive treatment (treatment × month; P < .001), regardless of CTO status (CTO status × treatment; P = .981 and CTO status × treatment × month; P = .264). The score increased over time with the largest improvement occurring at 3 months in both noninvasive (non-CTO, +7.82 [95% confidence interval (CI), 4.03-11.60] and CTO, +9.27 95% CI, 4.45-14.09) and early invasive (non-CTO, +26.17 [95% CI, 20.06-32.28] and CTO, +24.52 [95% CI, 17.40-31.64] groups. The mean score in CTO vs non-CTO groups did not differ at each timepoint, with a 12-month mean score of 70.26 (95% CI, 67.87-74.65) vs 71.17 (95% CI, 65.91-76.44) (P = .99) in the noninvasive treatment and 84.93 (95% CI, 78.90-90.97) vs 79.20 (95% CI, 72.77-86.14) (P = .31) in the early invasive treatment. CONCLUSIONS Patients with symptomatic PAD undergoing early revascularization exhibited better health status over time vs those undergoing noninvasive treatment strategy, irrespective of the presence of CTOs. The degree of the improvement was greater in the 3 months after the initial visit, especially in patients undergoing early revascularization.
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Affiliation(s)
- Roberto C Cerrud-Rodriguez
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Gaëlle Romain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Yasin Hussain
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jacob Cleman
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Santiago Callegari
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lindsey Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Psychiatry, Psychology Section, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
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Kornowski R. Patient-reported outcome measures in cardiovascular disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:119-127. [PMID: 34370009 DOI: 10.1093/ehjqcco/qcab051] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
In today's medical ecosystem, it is vital to measure the outcomes that are most important to the patients. As such, patient-reported outcome measures (PROMS) can be an essential metric to deliver high-quality cardiovascular care, particularly in the subset of patients who remain disappointed with their outcomes. PROMS should be a reproducible and reflective report of what is fundamental to a patient over time and across treatments with proper standards in the analysis, interpretation, and reporting of the collected data. These reports can also be sensitive to changes, whether improvements or deteriorations in the quality of care and medical attitude, but a lack of standardization makes it difficult to draw robust conclusions and compare findings across treatments. As a research tool, PROMS can have a significant prognostic prominence, offering a powerful instrument of comparison between different treatment modalities. With the information technology (IT) abilities of today, we can leverage mobile tools and powerful computer systems to perform sophisticated data analysis using patient-derived data and randomization. This may eliminate guesswork and generate impactful metrics to better inform the decision-making process. PROMS analysed by proper standardized algorithms can avoid physician bias and be integrated into the hospital teamwork. Therefore, there is a strong need for integration of PROMS into the evaluation of cardiovascular interventions and procedures, and establishment of international standards in the analyses of patient-reported outcomes and quality of life data to address this need and develop therapeutic recommendations.
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Affiliation(s)
- Ran Kornowski
- Rabin Medical Center, Belinson & Hasharon Hospitals, Petach Tikva & The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Le Faucheur A, Jéhannin P, Chanteau A, Blanc-Petitjean P, Donnelly A, Hoffmann C, Henni S, Bura-Rivière A, Kaladji A, Lanéelle D, Mahé G. A Multicenter, Investigator-Blinded, Randomized Controlled Trial to Assess the Efficacy of Calf Neuromuscular Electrical Stimulation Program on Walking Performance in Peripheral Artery Disease: The ELECTRO-PAD Study Protocol. J Clin Med 2022; 11:jcm11247261. [PMID: 36555879 PMCID: PMC9784261 DOI: 10.3390/jcm11247261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This paper describes a currently on-going multicenter, randomized controlled trial designed to assess the efficacy of calf neuromuscular electrical stimulation (NMES) on changes in maximal walking distance in people with lower extremity peripheral artery disease (PAD), compared with a non-intervention control-group. This study (NCT03795103) encompasses five participating centers in France. PAD participants with a predominant claudication at the calf level and a maximal treadmill walking distance ≤300 m are randomized into one of the two groups: NMES group or Control group. The NMES program consists of a 12-week program of electrical stimulations at the calf-muscle level. The primary outcome of the study is the change in maximal treadmill walking distance at 12 weeks. Main secondary outcomes include changes in the pain-free treadmill walking distance; 6 min total walking distance; global positioning system (GPS)-measured outdoor walking capacity; daily physical activity level by accelerometry; self-reported walking impairment; self-reported quality of life; ankle-brachial index; and skin microvascular function, both at the forearm and calf levels. Recruitment started in September 2019 and data collection is expected to end in November 2022.
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Affiliation(s)
- Alexis Le Faucheur
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
| | - Pierre Jéhannin
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
| | | | | | - Alan Donnelly
- PESS Department, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | | | - Samir Henni
- Vascular Medicine Department, CHU Angers, F-49000 Angers, France
- UMR CNRS 6015, INSERM 1083, Univ. Angers, F-49000 Angers, France
| | | | - Adrien Kaladji
- Vascular Surgery Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
| | - Damien Lanéelle
- Vascular Medicine Unit, CHU Caen-Normandie, University Hospital, F-14033 Caen, France
| | - Guillaume Mahé
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
- Vascular Medicine Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
- Correspondence: ; Tel.: +33-299-289-672
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Alipour S, Rashidi H, Maajani K, Orouji M, Eskandari Y. Development, validation, and implementation of a Short Breast Health Perception Questionnaire. BMC Public Health 2022; 22:1060. [PMID: 35624471 PMCID: PMC9137045 DOI: 10.1186/s12889-022-13501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Health status and perception can be assessed by general or disease-specific questionnaires, and disease specific questionnaires are more specific than general questionnaires. Considering the importance of breast health perception (BHP) in women's lives and the lack of any pertinent questionnaires, we performed this study to develop a valid and reliable short BHP questionnaire (BHPQ); and then used it to assess the participants' BHP. METHODS We first designed and developed the instrument and then measured its inter-rater agreement (IRA), content validity including content validity index (I-CVI) and scale content validity index (S-CVI), and reliability (through internal consistency and test-retest). We then evaluated the BHP of eligible women with normal breasts and benign breast disorders who attended our breast clinic. RESULTS The IRA index (78.6%) showed the optimal relevance and clarity of the questionnaire. The content validity was acceptable; with S-CVIs of 87.35 and 84.42 for clarity and relevance, respectively. The internal reliability was high (Cronbach's alpha = 0.93). Three questions were eliminated for internal consistency (intraclass correlation coefficient < 0.7) but the rest of the questions showed good and excellent reliability. In the next step, BHP in the 350 eligible participants showed an overall score of 43.89 ± 9.09. CONCLUSION This study introduces a valid and reliable 11-item BHPQ. We propose its use in various circumstances throughout breast cancer screening, diagnosis, and treatment; and in the assessment of BHP in various physiologic and reproductive situations.
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Affiliation(s)
- Sadaf Alipour
- Breast Disease Research Center (BDRC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Rashidi
- Breast Disease Research Center (BDRC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadije Maajani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Orouji
- Department of Nursing, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yas Eskandari
- Faculty of Psychology and Education, University of Tehran, Jalal Al-Ahmad St, Tehran, Iran.
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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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Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev 2021; 12:CD013139. [PMID: 34931303 PMCID: PMC8689147 DOI: 10.1002/14651858.cd013139.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Revised Cardiac Risk Index (RCRI) is a widely acknowledged prognostic model to estimate preoperatively the probability of developing in-hospital major adverse cardiac events (MACE) in patients undergoing noncardiac surgery. However, the RCRI does not always make accurate predictions, so various studies have investigated whether biomarkers added to or compared with the RCRI could improve this. OBJECTIVES Primary: To investigate the added predictive value of biomarkers to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Secondary: To investigate the prognostic value of biomarkers compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. Tertiary: To investigate the prognostic value of other prediction models compared to the RCRI to preoperatively predict in-hospital MACE and other adverse outcomes in patients undergoing noncardiac surgery. SEARCH METHODS We searched MEDLINE and Embase from 1 January 1999 (the year that the RCRI was published) until 25 June 2020. We also searched ISI Web of Science and SCOPUS for articles referring to the original RCRI development study in that period. SELECTION CRITERIA We included studies among adults who underwent noncardiac surgery, reporting on (external) validation of the RCRI and: - the addition of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of biomarker(s) to the RCRI; or - the comparison of the predictive accuracy of the RCRI to other models. Besides MACE, all other adverse outcomes were considered for inclusion. DATA COLLECTION AND ANALYSIS We developed a data extraction form based on the CHARMS checklist. Independent pairs of authors screened references, extracted data and assessed risk of bias and concerns regarding applicability according to PROBAST. For biomarkers and prediction models that were added or compared to the RCRI in ≥ 3 different articles, we described study characteristics and findings in further detail. We did not apply GRADE as no guidance is available for prognostic model reviews. MAIN RESULTS We screened 3960 records and included 107 articles. Over all objectives we rated risk of bias as high in ≥ 1 domain in 90% of included studies, particularly in the analysis domain. Statistical pooling or meta-analysis of reported results was impossible due to heterogeneity in various aspects: outcomes used, scale by which the biomarker was added/compared to the RCRI, prediction horizons and studied populations. Added predictive value of biomarkers to the RCRI Fifty-one studies reported on the added value of biomarkers to the RCRI. Sixty-nine different predictors were identified derived from blood (29%), imaging (33%) or other sources (38%). Addition of NT-proBNP, troponin or their combination improved the RCRI for predicting MACE (median delta c-statistics: 0.08, 0.14 and 0.12 for NT-proBNP, troponin and their combination, respectively). The median total net reclassification index (NRI) was 0.16 and 0.74 after addition of troponin and NT-proBNP to the RCRI, respectively. Calibration was not reported. To predict myocardial infarction, the median delta c-statistic when NT-proBNP was added to the RCRI was 0.09, and 0.06 for prediction of all-cause mortality and MACE combined. For BNP and copeptin, data were not sufficient to provide results on their added predictive performance, for any of the outcomes. Comparison of the predictive value of biomarkers to the RCRI Fifty-one studies assessed the predictive performance of biomarkers alone compared to the RCRI. We identified 60 unique predictors derived from blood (38%), imaging (30%) or other sources, such as the American Society of Anesthesiologists (ASA) classification (32%). Predictions were similar between the ASA classification and the RCRI for all studied outcomes. In studies different from those identified in objective 1, the median delta c-statistic was 0.15 and 0.12 in favour of BNP and NT-proBNP alone, respectively, when compared to the RCRI, for the prediction of MACE. For C-reactive protein, the predictive performance was similar to the RCRI. For other biomarkers and outcomes, data were insufficient to provide summary results. One study reported on calibration and none on reclassification. Comparison of the predictive value of other prognostic models to the RCRI Fifty-two articles compared the predictive ability of the RCRI to other prognostic models. Of these, 42% developed a new prediction model, 22% updated the RCRI, or another prediction model, and 37% validated an existing prediction model. None of the other prediction models showed better performance in predicting MACE than the RCRI. To predict myocardial infarction and cardiac arrest, ACS-NSQIP-MICA had a higher median delta c-statistic of 0.11 compared to the RCRI. To predict all-cause mortality, the median delta c-statistic was 0.15 higher in favour of ACS-NSQIP-SRS compared to the RCRI. Predictive performance was not better for CHADS2, CHA2DS2-VASc, R2CHADS2, Goldman index, Detsky index or VSG-CRI compared to the RCRI for any of the outcomes. Calibration and reclassification were reported in only one and three studies, respectively. AUTHORS' CONCLUSIONS Studies included in this review suggest that the predictive performance of the RCRI in predicting MACE is improved when NT-proBNP, troponin or their combination are added. Other studies indicate that BNP and NT-proBNP, when used in isolation, may even have a higher discriminative performance than the RCRI. There was insufficient evidence of a difference between the predictive accuracy of the RCRI and other prediction models in predicting MACE. However, ACS-NSQIP-MICA and ACS-NSQIP-SRS outperformed the RCRI in predicting myocardial infarction and cardiac arrest combined, and all-cause mortality, respectively. Nevertheless, the results cannot be interpreted as conclusive due to high risks of bias in a majority of papers, and pooling was impossible due to heterogeneity in outcomes, prediction horizons, biomarkers and studied populations. Future research on the added prognostic value of biomarkers to existing prediction models should focus on biomarkers with good predictive accuracy in other settings (e.g. diagnosis of myocardial infarction) and identification of biomarkers from omics data. They should be compared to novel biomarkers with so far insufficient evidence compared to established ones, including NT-proBNP or troponins. Adherence to recent guidance for prediction model studies (e.g. TRIPOD; PROBAST) and use of standardised outcome definitions in primary studies is highly recommended to facilitate systematic review and meta-analyses in the future.
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Affiliation(s)
- Lisette M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Anesthesiologist and R. Fraser Elliott Chair in Cardiac Anesthesia, Department of Anesthesia and Pain Management Toronto General Hospital, University Health Network and Professor, Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johanna Aag Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Hicks CW, Vavra AK, Goldsborough E, Rebuffatti M, Almeida J, Duwayri YM, Haurani M, Ross CB, Shah SK, Shireman PK, Smolock CJ, Yi J, Woo K. Current status of patient-reported outcome measures in vascular surgery. J Vasc Surg 2021; 74:1693-1706.e1. [PMID: 34688398 PMCID: PMC9834908 DOI: 10.1016/j.jvs.2021.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/14/2023]
Abstract
A previously published review focused on generic and disease-specific patient-reported outcome measures (PROMs) relevant to vascular surgery but limited to arterial conditions. The objective of this project was to identify all available PROMs relevant to diseases treated by vascular surgeons and to evaluate vascular surgeon perceptions, barriers to widespread implementation, and concerns regarding PROMs. We provide an overview of what a PROM is and how they are developed, and summarize currently available PROMs specific to vascular surgeons. We also report results from a survey of 78 Society for Vascular Surgery members serving on committees within the Policy and Advocacy Council addressing the barriers and facilitators to using PROMs in clinical practice. Finally, we report the qualitative results of two focus groups conducted to assess granular perceptions of PROMS and preparedness of vascular surgeons for widespread implementation of PROMs. These focus groups identified a lack of awareness of existing PROMs, knowledge of how PROMs are developed and validated, and clarity around how PROMs should be used by the clinician as main subthemes for barriers to PROM implementation in clinical practice.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ashley K Vavra
- Division of Vascular Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill
| | | | - Michelle Rebuffatti
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif
| | - Jose Almeida
- Miami Vein and Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, Fl
| | - Yazan M Duwayri
- Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, Ga
| | - Mounir Haurani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles B Ross
- Vascular Center of Excellence, Piedmont Heart and Vascular Institute, Piedmont Healthcare, Atlanta, Ga
| | - Samir K Shah
- Division of Vascular Surgery, University of Florida, Gainesville, Fl
| | - Paula K Shireman
- Division of Vascular and Endovascular Surgery, Long School of Medicine, University of Texas Health San Antonio, Tex; Department of Surgery, South Texas Veterans Health Care System, San Antonio, Tex
| | - Christopher J Smolock
- Department of Vascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Jeniann Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, Calif.
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Raja A, Spertus J, Yeh RW, Secemsky EA. Assessing health-related quality of life among patients with peripheral artery disease: A review of the literature and focus on patient-reported outcome measures. Vasc Med 2021; 26:317-325. [PMID: 33295253 PMCID: PMC8169614 DOI: 10.1177/1358863x20977016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Peripheral artery disease (PAD) is a progressive atherosclerotic disease associated with high rates of morbidity and mortality. Symptomatic PAD typically presents with claudication, and symptom severity strongly associates with reduced health-related quality of life (HRQoL). Existing treatment strategies for PAD are aimed at reducing symptom severity and improving functional outcomes. However, there is a need to incorporate patient-reported outcome measures (PROMs) into PAD treatment and research in order to provide more patient-centered care. This review will discuss the impact of PAD on HRQoL, existing PROMs available to assess PAD-related HRQoL, utilization of PROMs in research studies and registries, and challenges and solutions related to the integration of PROMs into research and clinical settings.
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Affiliation(s)
- Aishwarya Raja
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John Spertus
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Robert W Yeh
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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9
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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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10
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Derbas LA, Patel KK, Muskula PR, Wang J, Gosch K, Fitridge R, Spertus JA, Smolderen KG. Variability in utilization of diagnostic imaging tests in patients with symptomatic peripheral artery disease. Int J Cardiol 2021; 330:200-206. [PMID: 33581177 DOI: 10.1016/j.ijcard.2021.02.014] [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] [Received: 05/11/2020] [Revised: 12/20/2020] [Accepted: 02/05/2021] [Indexed: 01/09/2023]
Abstract
AIM Imaging can help guide management in peripheral arterial disease (PAD) with symptoms refractory to medical treatment. However, there are no set guidelines to determine when physicians should seek further imaging in patients with PAD for the assessment of new, persistent or worsening symptoms. This study describes the rates and variability in non-invasive and invasive imaging for patients presenting to vascular specialty clinics for symptomatic PAD. METHODS Patients (n=1,275) with a new PAD diagnosis or exacerbation of PAD symptoms were enrolled from 16 vascular clinics. Hierarchical logistic regression models were used to estimate the referral rates for 1) non-invasive and 2) invasive imaging tests, after adjusting for patient demographics, disease characteristics, PAQ summary score, PAD performance measures and country. Median Odds Ratios (MOR) were calculated to examine the variability across sites and providers. RESULTS Mean ABI was 0.67 ± 0.19. There were 690 (54.1%) patients who had imaging, of which 62 (9.0%) had invasive imaging. Imaging rates ranged from 8.6% to 98.6% across sites. The MOR for use of imaging for site was 3.36 (p < 0.001) and provider 3.49 (p < 0.001). The variability was explained primarily by (R2 = 29%) country followed by patient-level factors, provider and lastly site (R2 = 17%, 14%, and 13%, respectively). CONCLUSION There is wide variation in the use of imaging for patients presenting with new onset or recent exacerbations of their PAD. Country, followed by provider and site, were most strongly associated with this variability after adjusting for patient characteristics.
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Affiliation(s)
| | - Krishna K Patel
- University of Missouri Kansas City, Kansas City, MO, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | - Jingyan Wang
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Robert Fitridge
- The University of Adelaide, The Queen Elizabeth Hospital, Woodville, Australia
| | - John A Spertus
- University of Missouri Kansas City, Kansas City, MO, USA; Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Kim G Smolderen
- Yale School of Medicine, Department of Internal Medicine, Vascular Medicine Outcomes Program, Cardiovascular Medicine Section, New Haven, CT, USA.
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11
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Malik AO, Peri-Okonny P, Gosch K, Thomas MB, Mena C, Hiatt W, Aronow HD, Jones PG, Provance J, Labrosciano C, Jelani QUA, Spertus JA, Smolderen KG. Association of perceived stress with health status outcomes in patients with peripheral artery disease. J Psychosom Res 2021; 140:110313. [PMID: 33279876 PMCID: PMC8130536 DOI: 10.1016/j.jpsychores.2020.110313] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess association of chronic self-perceived stress with health status outcomes of patients with peripheral artery disease. METHODS The PORTRAIT study is a prospective registry that enrolled 1275 patients with symptoms of peripheral artery disease across 16-sites in US, Netherlands, and Australia from June 2011 to December 2015. Demographics, comorbidities and diagnostic information was abstracted from chart review. Self-perceived stress was assessed using the 4-item perceived stress scale at baseline, 3- and 6-month follow-up. Scores range from 0 to 16 with higher scores indicating greater stress. Sum scores were calculated at each time point and averaged to quantify average exposure to stress from enrollment through 6 months. Disease-specific health status were assessed at baseline and 12-months using the peripheral artery disease questionnaire summary score. RESULTS The mean age of the analytical cohort (n = 1060) was 67.7 ± 9.3 years, 37.1% were females, and 82.3% were white. Comorbidities were highly prevalent with 80.9% having hypertension, 32.6% having diabetes, and 36.4% being smokers. In models adjusted for demographics, comorbidities, disease severity and socioeconomic status, having a higher average stress score was associated with poorer recovery (from baseline) in peripheral artery disease questionnaire summary score at 12-months (-1.4 points per +1-point increase in averaged 4-point perceived stress score, 95% CI -2.1, -0.6 p < 0.001). CONCLUSION In patients with peripheral artery disease, experiencing higher chronic stress throughout the 6-months following their diagnosis, was independently associated with poorer recovery in 12-month disease-specific health status outcomes. (ClinicalTrial.gov identifier: NCT01419080).
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Affiliation(s)
- Ali O. Malik
- University of Missouri Kansas City Kansas City MO,Saint Lukes’ Mid America Heart Institute Kansas City MO
| | - Poghni Peri-Okonny
- University of Missouri Kansas City Kansas City MO,Saint Lukes’ Mid America Heart Institute Kansas City MO
| | - Kensey Gosch
- Saint Lukes’ Mid America Heart Institute Kansas City MO
| | | | | | | | | | - Phillip G. Jones
- University of Missouri Kansas City Kansas City MO,Saint Lukes’ Mid America Heart Institute Kansas City MO
| | | | | | | | - John A. Spertus
- University of Missouri Kansas City Kansas City MO,Saint Lukes’ Mid America Heart Institute Kansas City MO
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12
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Rymer JA, Mulder H, Smolderen KG, Hiatt WR, Conte MS, Berger JS, Norgren L, Mahaffey KW, Baumgartner I, Fowkes FG, Katona BG, Rockhold F, Jones WS, Patel MR. Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial. J Am Heart Assoc 2020; 9:e016573. [PMID: 32924754 PMCID: PMC7792388 DOI: 10.1161/jaha.120.016573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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 There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) trial, we examined the characteristics of 13 801 patients by tertile of health status instrument scores collected in the trial (EuroQol 5-Dimensions [EQ-5D], EQ visual analog scale [VAS], and peripheral artery questionnaire). We assessed the association between the baseline health status measurements and major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization procedures during trial follow-up and the association between 12-month health status change scores and subsequent end points during follow-up. There were 13 217 (95%) patients with EQ-5D scores, 13 533 (98%) with VAS scores, and 4431 (32%) with peripheral artery questionnaire scores. Patients in the lowest baseline EQ-5D tertile (0 to <0.69) were more likely to be female with severe claudication compared with the highest tertile (0.79-1.0; P<0.01). Patients in the lowest VAS (0-60) and peripheral artery questionnaire (0-49) tertiles had lower ankle-brachial indices compared with the highest tertiles (80-100 and 76-108, respectively; P<0.01). There was a significant association between baseline EQ-5D, VAS, and peripheral artery questionnaire scores and adjusted major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization (P<0.05). Improved EQ-5D and VAS scores over 12 months were associated with reduced risk of subsequent major adverse cardiovascular events or lower-extremity revascularization (all P<0.01). Conclusions Although health status instruments are rarely used in clinical practice, these measures are associated with outcomes, including major adverse cardiovascular events, major adverse limb events, and lower-extremity revascularization. Further research is needed to determine the relationship between changes in these instruments, revascularization, and outcomes.
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Affiliation(s)
- Jennifer A Rymer
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | | | - Kim G Smolderen
- Vascular Medicine Outcomes Program Yale University New Haven CT
| | - William R Hiatt
- Division of Cardiology and Colorado Prevention Center University of Colorado School of Medicine Aurora CO
| | - Michael S Conte
- Division of Vascular Surgery University of California San Francisco San Francisco CA
| | | | - Lars Norgren
- Faculty of Medicine and Health Orebro University Orebro Sweden
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research Stanford University School of Medicine Stanford CA
| | - Iris Baumgartner
- Swiss Cardiovascular Center Inselspital Bern University Hospital University of Bern Switzerland
| | - F Gerry Fowkes
- Usher Institute of Population Health Sciences and Informatics University of Edinburgh United Kingdom
| | | | - Frank Rockhold
- Duke Clinical Research Institute Durham NC.,Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC
| | - W Schuyler Jones
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- Division of Cardiology Duke University Medical Center Durham NC.,Duke Clinical Research Institute Durham NC
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13
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Level of disease and association with health status in patients presenting with claudication from the PORTRAIT registry. J Vasc Surg 2020; 72:2017-2026. [PMID: 32325227 DOI: 10.1016/j.jvs.2020.03.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Peripheral artery disease (PAD) has been shown to affect health status and quality of life; however, the disability associated by specific anatomic level of disease is unknown. We evaluated patients presenting with claudication by anatomic level and used the Peripheral Artery Questionnaire (PAQ), a PAD-specific validated tool, to quantify patients' symptoms, function, treatment satisfaction, and quality of life. METHODS The Patient-centered Outcomes Related to Treatment Practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT) registry is a multicenter, international, prospective study of patients with PAD. Anatomic level of PAD was stratified as follows: aortoiliac only, femoral-popliteal only, infrapopliteal only, and multilevel disease. Health status information was collected at baseline and at 3, 6, and 12 months using the PAQ. Student t-test, χ2 test, and linear mixed effects models were examined. RESULTS Anatomic data were present in 623 (48.9%) of 1275 patients: 127 aortoiliac (20.4%), 221 femoral-popliteal (35.5%), 39 infrapopliteal (6.3%), and 236 multilevel disease (37.9%). Groups were similar by sex and race. Baseline PAQ summary scores differed between lesions, with multilevel disease having the lowest (poorest) estimated PAQ summary score (P = .014). Patients with aortoiliac disease were significantly younger, were more likely to be smokers, and presented with higher ankle-brachial index (all P < .05). Almost one-fourth of patients underwent an intervention by 3 months, 83% of which were endovascular. Repeated-measures analyses demonstrated a significant association between anatomic lesion and PAQ scores over time (P = .016), even after adjustment for age, sex, work status, ankle-brachial index, smoking, history of diabetes and chronic kidney disease, and country. Multilevel disease had the lowest adjusted average PAQ summary score over time (63.1; 95% confidence interval [CI], 60.8-65.5) and was significantly lower than aortoiliac (68.1; 95% CI, 64.8-71.4; P = .02) and femoral-popliteal (68.2; 95% CI, 65.8-70.6; P = .002) but not infrapopliteal (66.2; 95% CI, 60.5-72.0; P = .32). CONCLUSIONS Overall, patients with claudication had similar health status on presentation by level of disease, yet patients with isolated aortoiliac disease fared significantly better over time with regard to quality of life and PAQ scores. Subset analysis demonstrated that patients undergoing interventions for aortoiliac disease and multilevel disease, which were primarily endovascular procedures, appeared to improve health status more over time compared with femoral-popliteal and infrapopliteal interventions. No significant benefits were found with intervention for femoral-popliteal disease or infrapopliteal disease compared with medical management. Treatment of aortoiliac and multilevel disease for claudication should be considered by clinicians as it may represent the greatest potential benefit for improving overall health status in patients with PAD. Further studies evaluating intervention compared with medical management alone are needed to further evaluate this finding.
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14
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A Qualitative Study Exploring Patient Concerns and Values in Chronic Limb-Threatening Ischemia. J Surg Res 2019; 243:289-300. [PMID: 31254902 DOI: 10.1016/j.jss.2019.05.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/01/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) is the debilitating end stage of peripheral artery disease, causing patients to experience low quality of life and poor health outcomes. It is unknown which aspects of care patients with CLTI value. This pilot qualitative study aims to explore patients' concerns and values related to CLTI treatment, to better inform patient-centered care. METHODS A qualitative study design was piloted to explore the experiences of patients with CLTI undergoing elective vascular surgery. In-depth, semistructured interviews were recorded preoperatively and 3 mo after discharge. Transcribed interviews were analyzed using content analysis, to derive patient-centered themes. Findings were mapped to a framework of patient-centered care. RESULTS Twelve interviews from six participants were analyzed. Five themes related to participant experiences of CLTI were identified: treatment and diagnosis, concerns about symptoms, limitations in physical function, social function, and emotional function. Participants expressed how CLTI intruded on all aspects of their lives. Framework analysis demonstrated CLTI patients valued patient-centered care relating to both relational and functional aspects of care. In particular, participants valued supportive and trustworthy care, in addition to integrated, holistic care that recognized the patient in the context of their overall health and life. CONCLUSIONS Feasibility was demonstrated for both study design and methodology. Data obtained from interviews were sufficiently "rich and thick" in quality and quantity to allow for common themes related to experience and health care values in patients with CLTI to be identified. If confirmed in future studies, these findings will enhance patient-centered care in CLTI.
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15
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Noyes AM, Abbott JD, Gosch K, Smolderen K, Spertus JA, Hyder O, Soukas P, Shishehbor MH, Aronow HD. Association between health status and sociodemographic, clinical and treatment disparities in the Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry. Vasc Med 2018; 23:32-38. [DOI: 10.1177/1358863x17747047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with peripheral artery disease (PAD) and intermittent claudication (IC) have impaired functional status and quality of life. However, little is known about which factors are associated with poorer health status at the time of initial presentation for PAD specialty care. Characterization of such features might provide insight into disparities that impact health status in this population. A total of 1258 patients from the United States, the Netherlands and Australia with new or worsened IC were enrolled at their first PAD specialty care visit between June 2011 and December 2015. The mean Peripheral Artery Questionnaire (PAQ) Summary Score (range 0–100), a disease-specific health status measure, was 49.2 ± 21.9. Hierarchical, multivariable linear regression was used to relate patient characteristics to baseline PAQ. Patient characteristics independently associated with poorer health status were age ( p < 0.001), female sex ( p < 0.001), not being married ( p = 0.02), economic burden (moderate/severe vs none, moderate/severe vs some; p = 0.03), difficulty getting care (moderate/severe vs none, moderate/severe vs some; p < 0.001), chronic lung disease ( p = 0.02), back pain ( p < 0.001), bilateral vs unilateral PAD ( p = 0.02), intermittent claudication severity (moderate vs mild, severe vs mild, p < 0.001), and lack of prior participation in an exercise program ( p = 0.005). Disparities in both vascular and non-vascular factors were associated with patients’ health status at the time of presentation and should be addressed by all who care for patients with vascular disease.
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Affiliation(s)
- Adam M Noyes
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - J Dawn Abbott
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Kensey Gosch
- Mid America Heart Institute of Saint Luke’s Hospital and the University of Missouri–Kansas City, Kansas City, MO, USA
| | - Kim Smolderen
- Mid America Heart Institute of Saint Luke’s Hospital and the University of Missouri–Kansas City, Kansas City, MO, USA
| | - John A Spertus
- Mid America Heart Institute of Saint Luke’s Hospital and the University of Missouri–Kansas City, Kansas City, MO, USA
| | - Omar Hyder
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Peter Soukas
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Mehdi H Shishehbor
- Case Western Reserve University School of Medicine, Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Herbert D Aronow
- Warren Alpert Medical School at Brown University, Lifespan Cardiovascular Institute, Providence, RI, USA
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16
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Abstract
Synopsis Claudication from peripheral artery disease (PAD) may mimic or coexist with musculoskeletal conditions and represents an important diagnostic consideration in patients over 50 years of age. Physical therapists are optimally positioned to recognize this condition by incorporating a vascular history and physical examination in appropriately selected patients. Recognition of PAD is important both from the standpoint of addressing the ischemic risk to the limb and because PAD is associated with high cerebrovascular and cardiovascular risk. Therefore, multidisciplinary management of patients with PAD is essential. Extensive evidence supports treatment of PAD-related claudication with supervised exercise, and physical therapists are well positioned to play an important role in this treatment. J Orthop Sports Phys Ther 2017;47(12):957-964. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7442.
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17
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Sukul D, Grey SF, Henke PK, Gurm HS, Grossman PM. Heterogeneity of Ankle-Brachial Indices in Patients Undergoing Revascularization for Critical Limb Ischemia. JACC Cardiovasc Interv 2017; 10:2307-2316. [PMID: 29169498 PMCID: PMC6800014 DOI: 10.1016/j.jcin.2017.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/26/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to describe the distribution of pre-intervention treated-limb ankle-brachial indices (ABIs) among patients with critical limb ischemia (CLI) undergoing percutaneous vascular intervention (PVI) or surgical revascularization (SR). BACKGROUND CLI is diagnosed by the presence of rest pain, tissue ulceration, or gangrene due to chronic arterial insufficiency. It is unclear what fraction of patients with suspected CLI have severe peripheral artery disease (PAD) on noninvasive functional testing. METHODS The study included patients who underwent lower extremity revascularization for CLI in a multicenter registry in Michigan from January 2012 through June 2015. ABIs were classified as normal (ABI: 0.91 to 1.40), mild-moderate (ABI: 0.41 to 0.90), and severe (ABI: ≤0.40). Pre- and post-intervention Peripheral Artery Questionnaire summary scores were assessed in a subset of patients. RESULTS Among 10,756 patients with signs or symptoms of CLI, 9,113 (84.7%) underwent PVI and 1,643 (15.3%) underwent SR. ABIs were recorded in 4,972 (54.6%) PVI and 1,012 (61.6%) SR patients. Patients undergoing PVI had higher ABIs than those undergoing SR, with substantial variation in both groups (PVI: 0.72 ± 0.29 vs. SR: 0.61 ± 0.29; p < 0.001). Nearly a quarter of patients with compressible arteries had normal ABIs (24.0%), whereas severe PAD was uncommon (16.5%). A significant improvement in Peripheral Artery Questionnaire scores was noted after intervention across all ABI categories. CONCLUSIONS Among patients undergoing revascularization for CLI in contemporary practice, the authors found substantial heterogeneity in pre-intervention ABIs. The disconnect between ABI results and clinical diagnosis calls into question the utility of ABIs in this population and suggests the need for standardization of functional PAD testing.
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Affiliation(s)
- Devraj Sukul
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Scott F Grey
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peter K Henke
- Department of Surgery, Division of Vascular Surgery, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Hitinder S Gurm
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - P Michael Grossman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
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18
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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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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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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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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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Conijn A, Jens S, Terwee C, Breek J, Koelemay M. Assessing the Quality of Available Patient Reported Outcome Measures for Intermittent Claudication: A Systematic Review Using the COSMIN Checklist. Eur J Vasc Endovasc Surg 2015; 49:316-34. [DOI: 10.1016/j.ejvs.2014.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Identification of International Classification of Functioning, Disability and Health Categories for Patients with Peripheral Arterial Disease. Am J Phys Med Rehabil 2014; 93:570-8. [DOI: 10.1097/phm.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karimi A, de Boer SW, van den Heuvel DAF, Fioole B, Vroegindeweij D, Heyligers JMM, Lohle PNM, Elgersma O, Nolthenius RPT, Vos JA, de Vries JPPM. Randomized trial of Legflow(®) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial. Trials 2013; 14:87. [PMID: 23537403 PMCID: PMC3651710 DOI: 10.1186/1745-6215-14-87] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 02/13/2013] [Indexed: 11/29/2022] Open
Abstract
Background Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow® paclitaxel-coated balloon (Cardionovum Sp.z.o.o., Warsaw, Poland) (LPEB) has been introduced. This balloon is covered with shellac, a Food and Drug Administration (FDA) approved natural resin, to obtain an equally distributed tissue concentration of paclitaxel. The RAPID trial is designed to assess restenosis after PTA using the Legflow balloon combined with nitinol stenting versus uncoated balloons with nitinol stenting in SFA lesions >5 cm. Methods/Design A total of 176 adult patients with Rutherford class 2 to class 6 symptoms due to intermediate (5–15 cm) or long (>15 cm) atherosclerotic lesions in the SFA will be randomly allocated for treatment with LPEB with nitinol stenting or uncoated balloon angioplasty with stenting. Stenting will be performed using the Supera® stent in both groups (IDEV Technologies Inc., Webster, TX). The primary endpoint is the absence of binary restenosis of the treated SFA segment. Secondary outcomes are target lesion revascularization (TLR), clinical and hemodynamic outcome, amputation rate, mortality rate, adverse events, and device-specific adverse events. Follow up consists of four visits in which ankle-brachial indices (ABI), toe pressure measurements, and duplex ultrasound (DUS) will be performed. Furthermore, a peripheral artery questionnaire (PAQ) will be completed by the patients at each follow-up. In the event that DUS reveals a symptomatic >50% restenosis, or a >75% asymptomatic restenosis, additional digital subtraction angiography will be performed with any necessary re-intervention. Discussion The RAPID trial is a multicenter randomized controlled patient blind trial that will provide evidence concerning whether the use of the Legflow paclitaxel/shellac coated balloons with nitinol stenting significantly reduces the frequency of restenosis in intermediate and long SFA lesions compared to standard PTA and stenting. Trial registration ISRCTN47846578
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Affiliation(s)
- Amine Karimi
- Department of Vascular Surgery, St. Antonius Hospital, PO box 2500, Nieuwegein, EM 3430, The Netherlands.
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McPhail S, Haines T. Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge. Health Qual Life Outcomes 2012; 10:94. [PMID: 22901009 PMCID: PMC3495730 DOI: 10.1186/1477-7525-10-94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 08/02/2012] [Indexed: 11/16/2022] Open
Abstract
Background Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients’ expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. Methods A prospective longitudinal cohort investigation of agreement between patients’ anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.
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Affiliation(s)
- Steven McPhail
- Centre for Functioning and Health Research, Buranda, Brisbane, Australia.
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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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Erdman RAM, Pedersen SS. Clinical and scientific progress related to the interface between cardiology and psychology: lessons learned from 35 years of experience at the Thoraxcenter of the Erasmus Medical Center in Rotterdam. Neth Heart J 2011; 19:470-6. [PMID: 21882002 PMCID: PMC3203984 DOI: 10.1007/s12471-011-0190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In November 1975, as the first in the Netherlands, a full-time psychologist was employed at the Department of Cardiology of the Thoraxcenter of the Erasmus Medical Center. This innovative decision was consistent with a view to treat the patient as a whole rather than the heart as a single body part in need of repair, combined with the understanding that the heart and mind interact to affect health. The present selective review addresses the broad range of contributions of 35 years of psychology to clinical cardiology and cardiovascular research with a focus on research, teaching, psychological screening and patient care. The review ends with lessons to be learned and challenges for the future with respect to improving the care and management of patients with heart disease in order to enhance secondary prevention and the role of behavioural and psychological factors in this endeavour.
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Affiliation(s)
- R A M Erdman
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands,
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Smoking Cessation has no Influence on Quality of Life in Patients with Peripheral Arterial Disease 5 Years Post-vascular Surgery. Eur J Vasc Endovasc Surg 2010; 40:355-62. [DOI: 10.1016/j.ejvs.2010.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/24/2010] [Indexed: 11/20/2022]
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Issa SM, Hoeks SE, Scholte op Reimer WJM, Van Gestel YRBM, Lenzen MJ, Verhagen HJM, Pedersen SS, Poldermans D. Health-related quality of life predicts long-term survival in patients with peripheral artery disease. Vasc Med 2010; 15:163-9. [DOI: 10.1177/1358863x10364208] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined whether health-related quality of life (HRQoL) predicts long-term survival in patients with peripheral artery disease (PAD) independent of established prognostic risk factors. In 2004, data on 711 consecutive patients with PAD undergoing vascular surgery were collected from 11 hospitals in The Netherlands. After 1 year, patients were contacted to complete the EuroQol Questionnaire (EQ-5D), of which 503 complied. HRQoL assessed by the EQ-5D was divided into tertiles (i.e. poor, intermediate and good HRQoL). Mortality was subsequently assessed 3 years after surgery. Of the 503 patients, 55 (11%) patients died during follow-up. Mortality was 21% in patients with poor HRQoL, 8% in patients with intermediate HRQoL, and 5% in patients with good HRQoL. Patients with poor HRQoL (HR = 5.4; 95% CI 2.3—12.5) had a worse survival compared to patients with a good HRQoL, after adjusting for established prognostic factors. In conclusion, the study indicates that poor HRQoL predicts long-term survival in patients with PAD, and provides prognostic value above established risk factors.
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Affiliation(s)
- Samson M Issa
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands, Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hence JM Verhagen
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Susanne S Pedersen
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands, Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Don Poldermans
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, 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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