Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) (PORTRAIT)
Patient-centered Outcomes Related to TReatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT Registry)
Study Overview
Status
Status
Conditions
Conditions
Detailed Description
Peripheral arterial disease (PAD) is a highly prevalent, but undertreated atherosclerotic disease with a disproportionately poor cardiovascular prognosis, as compared with other cardiovascular diseases. Cardiac events are, however, only one manifestation of PAD. Patients' health status (symptoms, function, and quality of life) are critical outcomes from patients' perspectives. To date, there have been no systematic prospective evaluations of disease-specific health status outcomes in PAD and how these vary by treatment and patient characteristics. The long-term goal of our work is to create an evidence-based multi-modal PAD management program that can be individualized to each patient. Following our preparatory work in Pilot PCORI grant 1 IP2 PI000753-01, the current proposal will develop a multi-center observational registry called PORTRAIT (Patient-centered Outcomes Related to Treatment Practices in peripheral Arterial disease: Investigating Trajectories). PORTRAIT will prospectively define and relate patients' care to their health status outcomes as a function of their treatment received at specialty clinics for new-onset, or exacerbations, of their PAD. We hypothesize that there will be substantial variability in treatment patterns across providers and by patient characteristics and that these will explain much of the variation in patients' health status outcomes. Four hypothesis-driven specific aims will be tested; the 5th aim will result in a direct deliverable from this study:
Aim 1: We hypothesize strong associations between the severity of patients' health status and the use of revascularization and that these will vary by age, gender, race, and socio-economic status. This aim will examine variations in treatment by patient characteristics as a foundation for identifying disparities in care.
Aim 2: We hypothesize that revascularization will be associated with more rapid, and larger, improvements in health status as compared with non-invasive options, and that these benefits will vary by age, gender, baseline health status, smoking cessation, minority race, and depressive symptoms. The primary objective of PORTRAIT is to quantify patients' PAD-specific health status outcomes overall, and as a function of treatment and patient characteristics.
Aim 3: We hypothesize that variations in performance measure adherence exist across providers, with greater adherence to pharmacologic therapies for prevention, than exercise treatments to improve function. We will compare real world PAD care against 4 PAD performance measures to provide insights into the quality of PAD care.
Aim 4: We hypothesize that variations in pharmacologic and supervised exercise will be associated with differences in health status outcomes and provide the evidence to suggest that failure to prescribe these evidence-based treatments will result in lower health status scores.
Aim 5: Use the new information to create educational tools to assist patients in selecting treatments.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Contacts and Locations
Study Locations
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Connecticut
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Bridgeport, Connecticut, United States, 06610
- Bridgeport Hospital
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New Haven, Connecticut, United States, 06520
- Yale University
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Louisiana
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New Orleans, Louisiana, United States, 70121
- Ochsner Health System
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Michigan
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Ann Arbor, Michigan, United States, 48106
- Saint Joseph Mercy Hospital
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Missouri
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Kansas City, Missouri, United States, 64111
- Saint Luke's Hospital of Kansas City
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Kansas City, Missouri, United States, 64108
- Truman Medical Center
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke University Medical Center
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-
Ohio
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Cleveland, Ohio, United States, 44195
- Cleveland Clinic
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Rhode Island
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Providence, Rhode Island, United States, 02903
- Rhode Island Hospital
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Providence, Rhode Island, United States, 02904
- Miriam Hospital
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Patients presenting to a PAD specialty clinic with new-onset exertional leg symptoms, or recent exacerbations of symptoms, will be screened for enrollment at 10 specialty PAD clinics. Trained study coordinators will have access to the outpatient clinic's schedule and be able to identify potentially eligible patients a priori so as to review medical records and identify potential patients. The diagnostic enrollment criterion includes a Doppler resting ankle-brachial index (ABI) ≤0.9026 or a significant drop in post-exercise ankle pressure of ≥20 mmHg. Patients will be asked to participate upon first visiting the PAD clinic, before treatment is started.
Study coordinators at each center will obtain informed consent and perform the baseline interview at the outpatient clinic.
Description
Inclusion Criteria:
- Age ≥ 21 years
- New or recent exacerbation of exertional leg symptoms
- Resting ankle-brachial index assessment ≤0.90 or drop in post-exercise ankle pressure ≥20 mmHg
Exclusion Criteria:
- Non-compressible ankle-brachial index (≥1.30)
- Critical limb ischemia
- Lower-limb endovascular or surgical vascular procedure in past year
- Not speaking either English or Spanish
- Hearing impaired
- Unable to provide written informed consent
- Currently a prisoner
Study Plan
How is the study designed?
Design Details
Number of groups / cohorts
Cohorts and Interventions
Group / CohortGroup / Cohort |
|---|
|
Peripheral Arterial Disease (PAD) patients
Patients with new onset or exacerbation of peripheral artery (PA) symptoms.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Peripheral Artery Disease (PAD) - Specific Health Status
Time Frame: One Year
|
Scores on a scale of 0-100 with higher scores representing better health status (0= worst health imaginable, 100= best health imaginable).
Subscales are weighed in a standardized scoring algorithm (proprietary).
Measures symptoms, symptom stability, and quality of life.
|
One Year
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
All-cause Mortality
Time Frame: One Year
|
all-cause mortality
|
One Year
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Kim Smolderen, PhD, St. Luke's Hospital, Kansas City, Missouri
- Principal Investigator: John A Spertus, MD, MPH, St. Luke's Hospital, Kansas City, Missouri
Publications and helpful links
General Publications
- Steg PG, Bhatt DL, Wilson PW, D'Agostino R Sr, Ohman EM, Rother J, Liau CS, Hirsch AT, Mas JL, Ikeda Y, Pencina MJ, Goto S; REACH Registry Investigators. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007 Mar 21;297(11):1197-206. doi: 10.1001/jama.297.11.1197.
- Angraal S, Hejjaji V, Tang Y, Gosch KL, Patel MR, Heyligers J, White CJ, Tutein Nolthenius R, Mena-Hurtado C, Aronow HD, Moneta GL, Fitridge R, Soukas PA, Abbott JD, Secemsky EA, Spertus JA, Smolderen KG. One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease. Circ Cardiovasc Interv. 2022 Jun;15(6):e011506. doi: 10.1161/CIRCINTERVENTIONS.121.011506. Epub 2022 May 17.
- Scierka LE, Jelani QU, Smolderen KG, Gosch K, Spertus JA, Mena-Hurtado C, Jones P, Dreyer RP. Patient representativeness of a peripheral artery disease cohort in a randomized control trial versus a real-world cohort: The CLEVER trial versus the PORTRAIT registry. Contemp Clin Trials. 2022 Jan;112:106624. doi: 10.1016/j.cct.2021.106624. Epub 2021 Nov 16.
- Jelani QU, Mena-Hurtado C, Gosch K, Mohammed M, Labrosciano C, Regan C, Scierka LE, Spertus JA, Nagpal S, Smolderen KG. Association of sleep apnea with outcomes in peripheral artery disease: Insights from the PORTRAIT study. PLoS One. 2021 Sep 10;16(9):e0256933. doi: 10.1371/journal.pone.0256933. eCollection 2021.
- Peri-Okonny PA, Wang J, Gosch KL, Patel MR, Shishehbor MH, Safley DL, Abbott JD, Aronow HD, Mena-Hurtado C, Jelani QU, 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 May;14(5):e007232. doi: 10.1161/CIRCOUTCOMES.120.007232. Epub 2021 May 5.
- Malik AO, Poghni Peri-Okonny, Gosch K, Thomas MB, Mena-Hurtado C, Hiatt W, Aronow HD, Jones PG, Provance J, Labrosciano C, Jelani QU, Spertus JA, Smolderen KG. Association of perceived stress with health status outcomes in patients with peripheral artery disease. J Psychosom Res. 2021 Jan;140:110313. doi: 10.1016/j.jpsychores.2020.110313. Epub 2020 Nov 24.
- Jelani QU, Mena-Hurtado C, Burg M, Soufer R, Gosch K, Jones PG, Spertus JA, Safdar B, Smolderen KG. Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences. J Am Heart Assoc. 2020 Aug 18;9(16):e014583. doi: 10.1161/JAHA.119.014583. Epub 2020 Aug 12.
- Jelani QU, Smolderen KG, Halpin D, Gosch K, Spertus JA, Iyad Ochoa Chaar C, Tutein Nolthenius RP, Heyligers J, De Vries JP, Mena-Hurtado C. Patient profiles and health status outcomes for peripheral artery disease in high-income countries: a comparison between the USA and The Netherlands. Eur Heart J Qual Care Clin Outcomes. 2021 Sep 16;7(5):505-512. doi: 10.1093/ehjqcco/qcaa052.
- Jelani QU, Jhamnani S, Spatz ES, Spertus J, Smolderen KG, Wang J, Desai NR, Jones P, Gosch K, Shah S, Attaran R, Mena-Hurtado C. Financial barriers in accessing medical care for peripheral artery disease are associated with delay of presentation and adverse health status outcomes in the United States. Vasc Med. 2020 Feb;25(1):13-24. doi: 10.1177/1358863X19872542. Epub 2019 Oct 11.
- Smolderen KG, Gosch K, Patel M, Jones WS, Hirsch AT, Beltrame J, Fitridge R, Shishehbor MH, Denollet J, Vriens P, Heyligers J, Stone MEd N, Aronow H, Abbott JD, Labrosciano C, Tutein-Nolthenius R, A Spertus J. PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study. Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e003860. doi: 10.1161/CIRCOUTCOMES.117.003860.
- Smolderen KG, Romain G, Gosch K, Arham A, Provance JB, Spertus JA, Poosala AB, Shishehbor MH, Safley D, Scott K, Stone N, Mena-Hurtado C. Patient knowledge and preferences for peripheral artery disease treatment. Vasc Med. 2023 Oct;28(5):397-403. doi: 10.1177/1358863X231181613. Epub 2023 Aug 28.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Estimated)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 11-533
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