One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease
Suveen Angraal, Vittal Hejjaji, Yuanyuan Tang, Kensey L Gosch, Manesh R Patel, Jan Heyligers, Christopher J White, Rudolf Tutein Nolthenius, Carlos Mena-Hurtado, Herbert D Aronow, Gregory L Moneta, Robert Fitridge, Peter A Soukas, J Dawn Abbott, Eric A Secemsky, John A Spertus, Kim G Smolderen, Suveen Angraal, Vittal Hejjaji, Yuanyuan Tang, Kensey L Gosch, Manesh R Patel, Jan Heyligers, Christopher J White, Rudolf Tutein Nolthenius, Carlos Mena-Hurtado, Herbert D Aronow, Gregory L Moneta, Robert Fitridge, Peter A Soukas, J Dawn Abbott, Eric A Secemsky, John A Spertus, Kim G Smolderen
Abstract
Background: Lifestyle changes and medications are recommended as the first line of treatment for claudication, with revascularization considered for treatment-resistant symptoms, based on patients' preferences. Real-world evidence comparing health status outcomes of early invasive with noninvasive management strategies is lacking.
Methods: In the international multicenter prospective observational PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry, disease-specific health status was assessed by the Peripheral Artery Questionnaire in patients with new-onset or worsening claudication at presentation and 3, 6, and 12 months later. One-year health status trajectories were compared by early revascularization versus noninvasive management on a propensity-matched sample using hierarchical generalized linear models for repeated measures adjusted for baseline health status.
Results: In a propensity-matched sample of 1000 patients (67.4±9.3 years, 62.8% male, and 82.4% White), 297 (29.7%) underwent early revascularization and 703 (70.3%) were managed noninvasively. Over 1 year of follow-up, patients who underwent early invasive management reported significantly higher health status than patients managed noninvasively (interaction term for time and treatment strategy; P<0.001 for all Peripheral Artery Questionnaire domains). The average 1-year change in Peripheral Artery Questionnaire summary scores was 30.8±25.2 in those undergoing early invasive, compared with 16.7±23.4 in those treated noninvasively (P<0.001).
Conclusions: Patients with claudication undergoing early invasive treatment had greater health status improvements over the course of 1 year than those treated noninvasively. These data can be used to support shared decision-making with patients.
Registration: URL: https://www.
Clinicaltrials: gov; Unique identifier: NCT01419080.
Keywords: health status; life style; patient preferences; quality of life; registries.
Source: PubMed