SEX DIFFERENCES IN DISEASE SPECIFIC HEALTH STATUS MEASURES IN PATIENTS WITH SYMPTOMATIC PERIPHERAL ARTERIAL DISEASE

Introduction: Patients with peripheral arterial disease (PAD) and coexisting diabetes mellitus (DM) have an increased rate of PAD progression and reduced walking performance as compared with non-diabetic PAD patients. It is unknown, however, whether patients with PAD and comorbid diabetes also experience worse PAD-specific health status (symptoms, functioning, quality of life) and what factors might mediate such a difference. Methods: PORTRAIT is a 16-center international registry that includes patients with exacerbated or new-onset symptomatic PAD presenting to specialty clinics. We measured PAD-specific health status at the time of PAD evaluation, 3, 6 and 12 months using the Peripheral Artery Questionnaire (PAQ). Hierarchical, multivariable, repeated measures analysis was used to assess the association between DM and health status at baseline and over time. Sequential adjustments for demographics, socioeconomic factors, PAD severity, comorbidities, psychosocial characteristics, primary treatment strategy and quality of care were made. Results: Of 1,204 patients, 398 patients had diabetes (33%, of whom 94% had Type II). Patients with PAD and DM had lower unadjusted PAQ summary scores at 0, 3, 6 and 12 months respectively (46.1 vs. 50.8, p < 0.001; 63.6 vs. 68.2, p < 0.01; 65.7 vs. 71.7, p < 0.001; 65.4 vs. 72.6, p <0.001). Patients with PAD and DM were more likely to be unemployed, depressed, of non-White race and to have more cardiovascular comorbidities, bilateral disease, non-healing ulcers and prior peripheral vascular interventions. When sequentially adjusting for relevant confounders, the effect for diabetes was mostly explained by comorbidities and psychosocial factors (Figure 1). Conclusion: Patients with PAD and co-existing DM have poorer health status upon PAD diagnosis and the year thereafter as compared with those who do not have DM, potentially explained by a higher burden of clinical comorbidities and psychosocial factors. Future work will need to further evaluate whether more emphasis on psychosocial aspects of care in these patients can improve their PAD-specific health status.

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Abstract 056: Age-specific Differences in Baseline Characteristics, Peripheral Arterial Disease Specific Health Status, and Patterns of Care in Patients With Peripheral Arterial Disease: Insights From the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.056 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

David Halpin ◽

Erica Spatz ◽

Bennet Cua ◽

Sunny Jhamnani ◽

Kim Smolderen ◽

...

Keyword(s):

Health Status ◽

Peripheral Arterial Disease ◽

Risk Reduction ◽

Arterial Disease ◽

Trend Test ◽

Age Cohorts ◽

Age Related ◽

Peripheral Arterial ◽

Specific Health

Background: The aging population along with the increased use of statins, anti-platelet agents, supervised exercise (SE) and smoking cessation (SC) may be altering the epidemiology of peripheral arterial disease (PAD) and may be delaying its onset. There are no insights into how older versus younger patients differ in terms of PAD severity, risk profiles, health status and treatment. We hypothesized that in the absence of any reliable age-related differences in treatment effectiveness, that risk reduction and revascularization would be used equally across PAD age cohorts. Aim: Assess age-specific differences in baseline characteristics, PAD-specific health status, and patterns of care in patients in the PORTRAIT registry. Methods: The PORTRAIT registry prospectively collected data from 1275 patients with new or worsening PAD symptoms who were treated in the US, the Netherlands or Australia between June 2011 and October 2015. Patients were grouped by age (< 60 years, 60 to ≤75 years, and > 75 years). We compared patient characteristics at the point of seeking specialty PAD care, including severity of PAD (Rutherford classification); health status assessed by the Peripheral Artery (PAQ) and EuroQol five dimensions (EQ5D) questionnaires; and subsequent clinical care offered for PAD, including statins, anti-platelet agents, SE, and SC. The use of revascularization (surgical or endovascular) was assessed at 3 months. Continuous variables were compared using the linear trend test. Categorical variables were compared using Mantel-Haenszel trend test. Results: There were 303 patients < 60 years (mean 55.0 ± 4.3), 675 patients 60 to ≤75 years (mean 67.8 ± 3.9), and 297 patients ≥ 75 years (mean 79.9 ± 4.1). There were no differences in baseline ABI (mean 0.66 ± 0.2, p=0.44) or Rutherford classification (p=0.47). PAQ summary, quality of life, social limitation, and symptom scores as well as EQ5D scores were significantly worse in patients < 60 years (p<0.001 for all indicators). Patients < 60 years were more likely to be current smokers (60.9% vs. 35.4%, vs. 17.5%, p<0.001). Risk reduction and quality of life (QOL) improvement PAD treatments that were comparable across age cohorts included: statins (p=0.10), SC (0.17), and referral for invasive therapy (p=0.34). In contrast, SE was prescribed more in patients < 60 years (p< 0.001) while anti-platelet therapy was used less often in this group (p=0.025). Conclusion: These data demonstrate that younger patients are characterized by worse PAD-specific health status at the time of entry into vascular specialty care and that there are age-related disparities in the prescription of PAD risk reduction and QOL improvement therapies. These data cannot document the reasons for these differences. Future quality improvement initiatives might focus on these disparities in presentation and care to improve outcomes in PAD.

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