1
|
Hejjaji V, Ellerbeck EF, Jones PG, Pacheco CM, Malik AO, Chan PS, Spertus JA, Arnold SV. Association Between Cardiovascular Event Type and Smoking Cessation Rates Among Outpatients With Atherosclerotic Cardiovascular Disease: Insights From the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes 2024; 17:e009960. [PMID: 38318702 DOI: 10.1161/circoutcomes.122.009960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND It is unclear how the type of an atherosclerotic cardiovascular disease (ASCVD) event potentially influences patients' likelihood of smoking cessation. METHODS Using 2013 to 2018 data from the US based National Cardiovascular Data Registry Practice Innovation and Clinical Excellence outpatient cardiac registry, we identified patients who were current smokers at a clinic visit and followed them over time for a subsequent ASCVD event. Self-reported smoking status was assessed at each consecutive visit and used to determine smoking cessation after each interim ASCVD event (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke/transient ischemic attack, peripheral artery disease). We constructed separate multivariable Cox models with nonproportional hazards to examine the association of each interim ASCVD event with smoking cessation, compared with not having an interim ASCVD event. We estimated the relative association of ASCVD event type with smoking cessation using contrast tests. Analyses were stratified by presence versus absence of ASCVD at baseline. RESULTS Across 530 cardiology practices, we identified 1 933 283 current smokers (mean age 62±15, male 54%, ASCVD at baseline 50%). Among the 322 743 patients who had an interim ASCVD event and were still smoking, 41 336 (12.8%) quit smoking by their first subsequent clinic visit, which was higher among those with baseline ASCVD (13.4%) as compared with those without baseline ASCVD (11.5%). Each type of ASCVD event was associated with an increased likelihood of smoking. Patients who had an myocardial infarction, underwent coronary artery bypass graft (hazard ratio, 1.60 [95% CI, 1.55-1.65]), or had a stroke or transient ischemic attack were more likely to quit smoking as compared with those who underwent elective percutaneous coronary intervention or had a new diagnosis of peripheral artery disease (hazard ratio, 1.20 [95% CI, 1.17-1.22]). CONCLUSIONS Only 13% of patients reported smoking cessation after an ASCVD event, with the type of event being associated with the likelihood of smoking cessation, prompting the need for patient-centered interventions.
Collapse
Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas School of Medicine, KS (E.F.E.)
| | - Philip G Jones
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, KS (C.M.P.)
| | - Ali O Malik
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Paul S Chan
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - John A Spertus
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| | - Suzanne V Arnold
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
- Department of Cardiovascular Medicine, University of Missouri-Kansas City, MO (V.H., P.G.J., A.O.M., P.S.C., J.A.S., S.V.A.)
| |
Collapse
|
2
|
Tollenaere Q, Métairie A, Le Pabic E, Le Faucheur A, Mahé G. Use of the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History questionnaire to detect maximal walking distance equal to or lower than 250 m in patients with lower extremity arterial disease. Front Cardiovasc Med 2023; 10:968213. [PMID: 37025694 PMCID: PMC10072320 DOI: 10.3389/fcvm.2023.968213] [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: 06/13/2022] [Accepted: 02/06/2023] [Indexed: 04/08/2023] Open
Abstract
Objective The objective was to assess the accuracy and optimal threshold of the Walking Impairment Questionnaire (WIQ) and the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in identifying patients with a maximal walking distance (MWD) below or equal to 250 m. Methods This retrospective study screened 388 consecutive patients with suspected symptomatic lower extremity arterial disease (LEAD). Collected data included the patient's history, resting ankle-brachial index, WIQ, and WELCH. MWD was assessed with a treadmill test at 2 mph (3.2 km/h) with a 10% grade. An optimized threshold for detection of MWD ≤ 250 m was determined for each questionnaire via receiver operating characteristic (ROC) curves. Subsequently, multivariate analysis was performed to build a new simple score to detect MWD ≤ 250 m. Results The study included 297 patients (63 ± 10 years old). With a threshold of ≤ 64%, the WIQ predicted MWD ≤ 250 m with an accuracy of 71.4% (66.2, 76.5%). With a threshold of ≤ 22, the WELCH predicted a treadmill walking distance of ≤ 250 m with an accuracy of 68.7% (63.4, 74.0%). A new score with only four "yes or no" questions had an accuracy of 71.4% (66.3, 76.6%). Items on this new score consisted of the level of difficulty of walking 1 block, declared maximum walking distance, usual walking speed, and maximum duration of slow walking. Conclusion A WIQ score ≤ 64% and a WELCH score ≤ 22 help to predict a walking distance of ≤ 250 m in a treadmill test at 2 mph (3.2 km/h) with a 10% grade. A 4-item score could be used for rapid evaluation of walking distance among patients with LEAD, but the validity of this 4-item score requires further confirmation studies.
Collapse
Affiliation(s)
- Quentin Tollenaere
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Antoine Métairie
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | | | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, M2S – EA 7470, Rennes, France
- *Correspondence: Guillaume Mahé
| |
Collapse
|
3
|
Rezvani F, Pelt M, Härter M, Dirmaier J. Effects of walking impairment on mental health burden, health risk behavior and quality of life in patients with intermittent claudication: A cross-sectional path analysis. PLoS One 2022; 17:e0273747. [PMID: 36048797 PMCID: PMC9436130 DOI: 10.1371/journal.pone.0273747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Intermittent claudication is the leading symptom of peripheral artery disease (leg pain when walking). The present study investigates the extent to which walking impairment is associated with health-related quality of life, mental health and health risk behavior. Methods A theory-based, cross-sectional path model was empirically examined using pre-intervention baseline data from a multicenter, randomized-controlled trial of patients with intermittent claudication (PAD-TeGeCoach). Data were available from 1 696 patients who completed a battery of questionnaires between April 14, 2018 and March 12, 2019, including measures of walking impairment (Walking Impairment Questionnaire), health-related quality of life (SF-12), mental burden (GAD-7, PHQ-9), nicotine- and alcohol-related risk behavior (Fagerström-Test, AUDIT-C). Sociodemographic characteristics and comorbid conditions were included in the postulated model a priori to minimize confounding effects. Results Walking impairment was associated with an increase in depressive (β = -.36, p < .001) and anxiety symptoms (β = -.24, p < .001). The prevalence of depressive and anxiety symptoms was 48.3% and 35.5%, respectively, with female patients and those of younger age being at greater risk. Depressive symptoms were predictive of an increased tobacco use (β = .21; p < .001). Walking impairment had adverse effects on physical quality of life, both directly (β = .60, p < .001) and indirectly mediated through depressive symptoms (β = -.16, p < .001); and indirectly on mental quality of life mediated through depressive (β = -.43, p < .001) and anxiety symptoms (β = -.35, p < .001). Discussion The findings underscore the need for a comprehensive treatment strategy in patients with intermittent claudication. Measures to improve walking impairment (e.g. exercise training) are key to enhance quality of life and should be the primary treatment. As a key mediator of mental quality of life, depressive and anxiety symptoms should be addressed by rigorously including mental health treatment. Risky health behaviors should be approached by promoting behavior change (e.g. smoking cessation) as a secondary prevention of peripheral artery disease.
Collapse
Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Mara Pelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Amialchuk A, Sapci O. The long-term health effects of initiating smoking in adolescence: Evidence from a national longitudinal survey. HEALTH ECONOMICS 2022; 31:597-613. [PMID: 34989036 DOI: 10.1002/hec.4469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 10/20/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
We estimate the long-term effect of initiating smoking in adolescence on a range of health outcomes later in life. We use the second wave (1996) and the fifth wave (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and estimate instrumental variables models with school-level fixed effects, where the instruments are the average rate of smoking among friends and the respondents' perceptions about their friends' smoking. We find that smoking in adolescence has a negative impact on 15 of the 28 self-reported, diagnosed, and self-identified health outcomes approximately 20 years later.
Collapse
Affiliation(s)
| | - Onur Sapci
- Department of Economics, University of Toledo, Toledo, Ohio, USA
| |
Collapse
|
5
|
Li Y, Hendryx MS, Xun P, He K, Shadyab AH, Lane DS, Nassir R, Stefanick ML, Wactawski-Wende J, Pal SK, Luo J. Physical activity and risk of bladder cancer among postmenopausal women. Int J Cancer 2020; 147:2717-2724. [PMID: 32390249 DOI: 10.1002/ijc.33042] [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: 10/15/2019] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 11/11/2022]
Abstract
Physical activity is associated with decreased risk for many cancers. Studies on the association between physical activity and risk of bladder cancer are limited, and findings are inconsistent. Postmenopausal women (mean age = 63.3) were recruited into the Women's Health Initiative from 1993 to 1998. Self-reported baseline information on physical activity and other covariates were available in 141 288 participants. Incident bladder cancer cases were collected through 2018 and centrally adjudicated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined by Cox proportional hazard regression models. Effect modification due to smoking was assessed. During an average of 18.5 years of follow-up, 817 bladder cancer cases were identified. Compared to physically inactive women, those who engaged in ≥15 MET-hours/week of total physical activity, ≥8.75 MET-hours/week of walking or ≥11.25 MET-hours/week of moderate to vigorous physical activity had lower risk of bladder cancer (HR = 0.74, 95% CI: 0.59-0.94, P for linear trend = .02; HR = 0.79, 95% CI: 0.63-0.98, P for linear trend = .03; and HR = 0.76, 95% CI: 0.61-0.94, P for linear trend = .02, respectively). No effect modification was found by smoking status (P for interaction = .06, 0.91 and 0.27, respectively). We found that total physical activity, walking and moderate to vigorous physical activity were inversely associated with bladder cancer incidence among postmenopausal women in a dose-response manner. Physical activity may play a potential role in the primary prevention of bladder cancer. Further studies with objective measurements of physical activity are needed to confirm these findings.
Collapse
Affiliation(s)
- Yueyao Li
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| | - Michael S Hendryx
- Department of Environmental and Occupational Health, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| | - Ka He
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Aladdin H Shadyab
- Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Dorothy S Lane
- Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Rami Nassir
- Department of Pathology, School of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, School of Public Health and Health Professions, Buffalo, New York, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, Bloomington, Indiana, USA
| |
Collapse
|
6
|
Bauersachs R, Debus S, Nehler M, Huelsebeck M, Balradj J, Bowrin K, Briere JB. A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease. Angiology 2019; 71:303-314. [DOI: 10.1177/0003319719896477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.
Collapse
Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmBH, Darmstadt, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery, Angiology, Endovascular Interventions, University of Hamburg-Eppendorf, Hamburg Germany
| | - Mark Nehler
- Vascular Surgery and Endovascular Therapy Faculty, University of Colorado and CPC Research, Denver, CO, USA
| | | | | | | | | |
Collapse
|
7
|
Patel KK, Jones PG, Ellerbeck EF, Buchanan DM, Chan PS, Pacheco CM, Moneta G, Spertus JA, Smolderen KG. Underutilization of Evidence-Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry. J Am Heart Assoc 2019; 7:e010076. [PMID: 30371269 PMCID: PMC6474973 DOI: 10.1161/jaha.118.010076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Smoking is the most important risk factor for peripheral artery disease (PAD). Smoking cessation is key in PAD management. We aimed to examine smoking rates and smoking cessation interventions offered to patients with PAD consulting a vascular specialty clinic; and assess changes in smoking behavior over the year following initial visit. Methods and Results A total of 1272 patients with PAD and new or worsening claudication were enrolled at 16 vascular specialty clinics (2011–2015, PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry). Interviews collected smoking status and cessation interventions at baseline, 3, 6, and 12 months. Among smokers, transition state models analyzed smoking transitions at each time point and identified factors associated with quitting and relapse. On presentation, 474 (37.3%) patients were active, 660 (51.9%) former, and 138 (10.8%) never smokers. Among active smokers, only 16% were referred to cessation counseling and 11% were prescribed pharmacologic treatment. At 3 months, the probability of quitting smoking was 21%; among those continuing to smoke at 3 months, the probability of quitting during the next 9 months varied between 11% and 12% (P<0.001). The probability of relapse among initial quitters was 36%. At 12 months, 72% of all smokers continued to smoke. Conclusions More than one third of patients with claudication consulting a PAD provider are active smokers and few received evidence‐based cessation interventions. Patients appear to be most likely to quit early in their treatment course, but many quickly relapse and 72% of all patients smoking at baseline are still smoking at 12 months. Better strategies are needed to provide continuous cessation support. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
Collapse
Affiliation(s)
- Krishna K. Patel
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Philip G. Jones
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | - Donna M. Buchanan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Paul S. Chan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | | | - John A. Spertus
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Kim G. Smolderen
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| |
Collapse
|
8
|
Influence of smoking on physical function, physical activity, and cardiovascular health parameters in patients with symptomatic peripheral arterial disease: A cross-sectional study. JOURNAL OF VASCULAR NURSING 2019; 37:106-112. [PMID: 31155156 DOI: 10.1016/j.jvn.2019.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 12/24/2022]
Abstract
The aim of this study was to analyze the impact of smoking on physical activity, walking capacity, and cardiovascular health in patients with symptomatic peripheral arterial disease (PAD). This cross-sectional study included 180 patients with symptomatic PAD. Patients were classified into 3 groups according to smoking history: smoker (n = 39), ex-smoker (n = 113), and never smoker (n = 28). Physical activity levels, physical function, walking capacity, and cardiovascular health parameters (clinical blood pressure, arterial stiffness, and heart rate variability) were assessed. Smoker patients presented higher sympathetic modulation to the heart (low frequency of heart rate variability: smokers, 71 ± 17 nu; ex-smokers, 53 ± 32 nu; never smokers, 49 ± 21 nu, P < .05) and sympathovagal balance (smokers: 2.44 ± 2.76, ex-smokers: 1.14 ± 1.74, never smokers: 1.04 ± 0.99, P < .05) and lower parasympathetic modulation to the heart (high frequency of heart rate variability: smokers, 29 ± 27 nu; ex-smokers, 47 ± 32 nu; never smokers, 51 ± 21 nu, P < .05) than other patients. In conclusion, nonsignificant differences were observed on physical activity levels, physical function, blood pressure, and arterial stiffness (P > .05). Smoking impairs cardiac autonomic modulation in patients with symptomatic PAD.
Collapse
|
9
|
Mezdad T, Henni S, Feuilloy M, Chauvet P, Schang D, Abraham P. Identification of new factors associated to walking impairment in patients with vascular-type claudication. Vascular 2018; 27:260-269. [PMID: 30442076 DOI: 10.1177/1708538118813708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mechanisms of walking limitation in arterial claudication are incompletely elucidated. We aimed to identify new variables associated to walking limitation in patients with claudication. METHODS We retrospectively analyzed data of 1120 patients referred for transcutaneous exercise oxygen pressure recordings (TcpO2). The outcome measurement was the absolute walking time on treadmill (3.2 km/h, 10% slope). We used both: linear regression analysis and a non-linear analysis, combining support vector machines and genetic explanatory in 800 patients with the following resting variables: age, gender, body mass index, the presence of diabetes, minimal ankle to brachial index at rest, usual walking speed over 10 m (usual-pace), number of comorbid conditions, active smoking, resting heart rate, pre-test glycaemia and hemoglobin, beta-blocker use, and exercise-derived variables: minimal value of pulse oximetry, resting chest-TcpO2, decrease in chest TcpO2 during exercise, presence of buttock ischemia defined as a decrease from rest of oxygen pressure index ≤15 mmHg. We tested the models over 320 other patients. RESULTS Independent variables associated to walking time, by decreasing importance in the models, were: age, ankle to brachial index, usual-pace; resting TcpO2, body mass index, smoking, buttock ischemia, heart rate and beta-blockers for the linear regression analysis, and were ankle to brachial index, age, body mass index, usual-pace, decrease in chest TcpO2, smoking, buttock ischemia, glycaemia, heart rate for the non-linear analysis. Testing of models over 320 new patients gave r = 0.509 for linear and 0.575 for non-linear analysis (both p < 0.05). CONCLUSION Buttock ischemia, heart rate and usual-pace are new variables associated to walking time.
Collapse
Affiliation(s)
| | - Samir Henni
- 1 Vascular Medicine, University Hospital, Angers, France
| | | | | | | | - Pierre Abraham
- 4 Exercise and Sports Medicine, University Hospital, Angers, France.,5 INSERM 1083, CNRS 6015, LUNAM Université, Angers, France
| |
Collapse
|
10
|
Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program. PLoS One 2018; 13:e0201095. [PMID: 30048501 PMCID: PMC6062088 DOI: 10.1371/journal.pone.0201095] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. AIM To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. METHODS A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. RESULTS Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. CONCLUSIONS This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418.
Collapse
|
11
|
Kim J, Garcia-Esquinas E, Navas-Acien A, Choi YH. Blood and urine cadmium concentrations and walking speed in middle-aged and older U.S. adults. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 232:97-104. [PMID: 28941716 DOI: 10.1016/j.envpol.2017.09.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/21/2017] [Accepted: 09/03/2017] [Indexed: 05/10/2023]
Abstract
Reduced physical performance is an important feature of aging, and walking speed is a valid measure of physical performance and mobility in older adults. Previous epidemiological studies suggest that cadmium exposure, even at low environmental levels, may contribute to vascular, musculoskeletal, and cognitive dysfunction, which may all be associated with reductions in physical performance. To this end, we investigated the associations of blood and urine cadmium concentrations with walking speed in middle-aged and older adults in the U.S. general population. We studied U.S. adults from the National Health and Nutrition Examination Survey 1999 to 2002 who were ≥50 years of age, who had determinations of cadmium in blood or in urine, and who had measurements of the time taken to walk 20 feet. Walking speed (ft/sec) was computed as walked distance (20 ft) divided by measured time to walk (in seconds). The weighted geometric means of blood and urine cadmium were 0.49 [95% confidence interval (CI): 0.47, 0.52] μg/L and 0.37 (95% CI: 0.34, 0.42) ng/mL, respectively. After adjusting for sociodemographic, anthropometric, health-related behavioral, and clinical risk factors and inflammation markers, the highest (vs. lowest) quintile of blood cadmium was associated with a 0.18 (95% CI: 0.10, 0.25) ft/sec reduction in walking speed (p-Trend <0.001). No association was observed for urine cadmium levels with walking speed. Cadmium concentrations in blood, but not in urine, were associated with slower gait speed. Our findings add to the growing volume of evidence supporting cadmium's toxicity even at low levels of exposure.
Collapse
Affiliation(s)
- Junghoon Kim
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Esther Garcia-Esquinas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPaz, and Ciber of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA; Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Yoon-Hyeong Choi
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea; Gachon Advanced Institute for Health Sciences and Technology, Gachon University, Incheon, Republic of Korea.
| |
Collapse
|
12
|
Harwood AE, Totty JP, Broadbent E, Smith GE, Chetter IC. Quality of life in patients with intermittent claudication. GEFASSCHIRURGIE 2017; 22:159-164. [PMID: 28529410 PMCID: PMC5413525 DOI: 10.1007/s00772-017-0269-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Intermittent claudication (IC) is a common condition that causes pain in the lower limbs when walking and has been shown to severely impact the quality of life (QoL) of patients. The QoL is therefore often regarded as an important measure in clinical trials investigating intermittent claudication. To date, no consensus exits on the type of life questionnaire to be used. This review aims to examine the QoL questionnaires used in trials investigating peripheral arterial disease (PAD). Material and methods A systematic review of randomised clinical trials including a primary analysis of QoL via questionnaire was performed. Trials involving patients with diagnosed PAD were included (either clinically or by questionnaire). Any trial which had QoL as the primary outcome data was included with no limit being placed on the type of questionnaire used. Results The search yielded a total of 1845 articles of which 31 were deemed appropriate for inclusion in the review. In total, 14 different QoL questionnaires were used across 31 studies. Of the questionnaires 24.06% were missing at least one domain when reported in the results of the study. Mean standard deviation varied widely based on the domain reported, particularly within the SF36. Discussion Despite previous recommendations for Europewide standardisation of quality of life assessment, to date no such tool exists. This review demonstrated that a number of different questionnaires remain in use, that their completion is often inadequate and that further evidence-based guidelines on QoL assessment are required to guide future research.
Collapse
Affiliation(s)
- A E Harwood
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - J P Totty
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - E Broadbent
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - G E Smith
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, HU3 2JZ Hull, UK
| |
Collapse
|
13
|
Monaro S, West S, Gullick J. An integrative review of health-related quality of life in patients with critical limb ischaemia. J Clin Nurs 2017; 26:2826-2844. [PMID: 27808440 DOI: 10.1111/jocn.13623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the domains and the domain-specific characteristics within a peripheral arterial disease health-related quality of life framework for their usefulness in defining critical limb ischaemia health-related quality of life. BACKGROUND Critical Limb Ischaemia presents a highly individualised set of personal and health circumstances. Treatment options include conservative management, revascularisation or amputation. However, the links between treatment decisions and quality of life require further investigation. DESIGN The framework for this integrative review was the peripheral arterial disease-specific health-related quality of life domains identified by Treat-Jacobson et al. RESULTS The literature expanded and refined Treat-Jacobson's framework by modifying the characteristics to better describe health-related quality of life in critical limb ischaemia. CONCLUSIONS Given that critical limb ischaemia is a highly individualised situation with powerful health-related quality of life implications, further research focusing on patient and family-centred decision-making relating to therapeutic options and advanced care planning is required. RELEVANCE TO CLINICAL PRACTICE A critical limb ischaemia-specific, health-related quality of life tool is required to capture both the unique characteristics of this disorder, and the outcomes for active or conservative care among this complex group of patients.
Collapse
Affiliation(s)
- Susan Monaro
- Concord Repatriation General Hospital, Concord, NSW, Australia.,Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Sandra West
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Janice Gullick
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
14
|
Baltic A, Baljic R, Radjo I, Mlaco A. Health Effects of the Programmed Physical Activities on Lipid Profile in Peripheral Arterial Disease of the Lower Extremities. Med Arch 2015; 69:311-4. [PMID: 26622083 PMCID: PMC4639366 DOI: 10.5455/medarh.2015.69.311-314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/02/2015] [Indexed: 11/11/2022] Open
Abstract
AIMS Determine health effects of programmed physical activities on blood fats in peripheral arterial disease of lower limbs or in examinees on medication therapy and examinees performing programmed physical activities along with the medication therapy. METHODS Overall research has been carried out at the Clinic for Vascular Disease CCUS. Before involvement into the study, examinees had to meet the inclusion criteria. Research was carried out as randomized controlled trial including 100 patients with arterial disease of lower limbs, who meet inclusion criteria: control group (CG, n=50) and test group (TG, n=50). Total level of cholesterol was used for effects assessment of 28 weeks of applied programmed activity in patients. RESULTS Values of total cholesterol (tCh) and triglycerides before and after treatment in patients of CG and TG showed statistically significant change of its mean values. Significant decrease were marked in tCh and triglycerides levels in TG compared to CG. CONCLUSION Adequate programmed physical activities in patients with peripheral vascular disease appeared as very successful in treated patients. Results indicate statistically significant decrease of the cholesterol and triglycerides after the treatment. Physical activity used in the treatment made partial regression of arterial diseases and saved patients for undergoing to surgery. Lower level of total cholesterol represents a ten year period prevention of initial stage in progress of arterial diseases.
Collapse
Affiliation(s)
- Abel Baltic
- Clinic for Vascular Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Rusmir Baljic
- Clinic for Infection Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Izet Radjo
- Clinic for Infection Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Akif Mlaco
- Clinic for Vascular Diseases, Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
15
|
The Contribution of Tobacco Use to High Health Care Utilization and Medical Costs in Peripheral Artery Disease. J Am Coll Cardiol 2015; 66:1566-1574. [DOI: 10.1016/j.jacc.2015.06.1349] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/04/2015] [Accepted: 06/18/2015] [Indexed: 11/21/2022]
|
16
|
Goldenberg M, Danovitch I, IsHak WW. Quality of life and smoking. Am J Addict 2014; 23:540-62. [DOI: 10.1111/j.1521-0391.2014.12148.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/23/2014] [Accepted: 05/12/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Itai Danovitch
- Cedars-Sinai Medical Center; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Waguih William IsHak
- Cedars-Sinai Medical Center; David Geffen School of Medicine at UCLA; Los Angeles California
| |
Collapse
|