scholarly journals Association of sleep apnea with outcomes in peripheral artery disease: Insights from the PORTRAIT study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256933
Author(s):  
Qurat-ul-ain Jelani ◽  
Carlos Mena-Hurtado ◽  
Kensey Gosch ◽  
Moghniuddin Mohammed ◽  
Clementine Labrosciano ◽  
...  
Keyword(s):  
Health Status ◽  
Sleep Apnea ◽  
Peripheral Artery Disease ◽  
Rank Test ◽  
Peripheral Artery ◽  
Clinical Trial Registration ◽  
The Us ◽  
History Of ◽  
Artery Disease

Background Sleep apnea is a predictor of adverse cardiovascular outcome in many cardiovascular diseases but whether it is associated with worse health status outcomes or mortality in peripheral artery disease (PAD) is unknown. Methods PORTRAIT is an international (US, Netherlands, Australia) prospective PAD registry that consecutively enrolled patients who presented with new-onset or recent exacerbations of PAD symptoms to any of 16 vascular specialty clinics. Health status was assessed upon presentation and at 12 months with the disease-specific Peripheral Artery Questionnaire (PAQ). Higher PAQ scores indicate better health status. A sequentially-adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ symptoms, quality of life, and summary scores. Five-year survival curves by comorbid sleep apnea status for US patients were compared using the log-rank test. Results The mean age of the 1204 PORTRAIT participants was 67.6 ± 9.4 years with 37.5% women and 8.3% (n = 100) having sleep apnea. Patients with sleep apnea were more likely to be from the US, more sedentary, and to have diabetes, obesity, coronary disease, more depressive symptoms and a history of prior peripheral interventions. Paradoxically, they also had higher ankle-brachial indices, but lower PAQ Summary scores at presentation and 12 months (41.2 ± 22.0 vs. 49. 9± 21.6 and 58.6 ± 27.9 vs. 71.3 ± 24.9, respectively, p = <0.05). The association between sleep apnea and 1-year health status persisted after multivariable adjustment, but there were no differences in all-cause mortality over 5 years (28.0% vs. 23.4%, p = 0.76). Conclusion In patients presenting with PAD, comorbid sleep apnea is independently associated with worse health status over time. Future studies should test whether better treatment of sleep apnea can improve the health status of patients with PAD. Clinical trial registration NCT01419080

Abstract 212: The Association of Sleep Apnea With 1-year Health Status Outcomes in Patients With Peripheral Artery Disease

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Qurat-ul-ain Jelani ◽  
Carlos Mena-hurtado ◽  
Kensey Gosch ◽  
Moghniuddin Mohammed ◽  
Sameer Nagpal ◽  
...  
Keyword(s):  
Health Status ◽  
Sleep Apnea ◽  
Ankle Brachial Index ◽  
Women Patients ◽  
Peripheral Artery ◽  
The Us ◽  
History Of ◽  
Lower Health ◽  
Artery Disease ◽  
Specific Health

Background: Comorbid sleep apnea in cardiovascular disease is a predictor of adverse cardiovascular outcomes. It is unknown whether comorbid sleep apnea in PAD is associated with worse PAD-specific health status outcomes. Methods: PORTRAIT is an international (US, Netherlands, Australia), 16-center, prospective PAD registry. Health status was assessed upon PAD diagnosis and at 12 months (disease-specific Peripheral Artery Questionnaire, PAQ Summary scores). Higher PAQ scores indicate better health status. A sequentially adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ scores (figure). Results: Of the 1204 patients with PAD, 8.3% (n=100) had comorbid sleep apnea. The mean age was 67.6 ± 9.4 with 37.5% women. Patients with vs. without sleep apnea were more from the US; more sedentary, presented with more diabetes, obesity, coronary disease and a history of peripheral interventions, but had higher ankle-brachial index values. They also had lower health status scores at presentation and 12 months (41.2 ± 22.0 vs 49.9±21.6 and 58.6±27.9 vs71.3±24.9, respectively, p<0.05). The association between sleep apnea and 1-year health status persisted after adjustment (Figure). Conclusion: In patients presenting with PAD, comorbid sleep apnea clusters with an overall toxic cardiovascular risk profile. Independent of these risk factors, patients with PAD and sleep apnea obtain less favorable PAD-specific 1-year PAD-specific health status outcomes. Figure: The Association Between Sleep Apnea and 1-Year PAQ Summary Scores Following Sequential Adjustment for Demographics, Socioeconomic Factors, PAD severity, Psychosocial Factors and Baseline Health Status Score. Estimates represent Beta coefficients and 95% confidence intervals.

Time trends in use of cardioprotective medication in patients with peripheral artery disease between 1997 and 2016: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kamil ◽  
T.S.G Sehested ◽  
K Houlind ◽  
J.F Lassen ◽  
G Gislason ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Ace Inhibitors ◽  
Lifestyle Modification ◽  
Temporal Trends ◽  
Peripheral Artery ◽  
Nationwide Study ◽  
History Of ◽  
Artery Disease ◽  
First Time ◽  
Time Diagnosis

Abstract Background Peripheral artery disease (PAD) is associated with increased cardiovascular (CV) morbidity and mortality. Aggressive management of risk factors and lifestyle modification may improve outcomes for patients with PAD. The present study aims to investigate changes in use of cardioprotective medication after the incident diagnosis of PAD between 1997 and 2016. Methods By using Danish national healthcare registries, we identified all patients with first-time diagnosis of PAD between 1997 and 2016. These patients were classified into 2 main groups: PAD-all (n=167,762) that includes all PAD patients with or without a history of CVD, including myocardial infarction (MI), atrial fibrillation (AF), and stroke (n=167,761) and PAD-only (n=87,935) that comprise patients with PAD without a history of AF, MI, and stroke. We calculated temporal trends and assessed comparative use of cardioprotective medication in the first 12 months after the incident diagnosis of PAD. Results Our results showed an improved use of cardioprotective medication temporally in both groups. However, PAD-all were marginally better treated (Aspirin, 3.5% - 48.4%; Clopidogrel, 0% - 17.6%; VKA 0.9% - 7.8%; NOACs 0.0% - 10.1%; Statins, 1.9%- 58.1%; ACE-inhibitors, 1.2% - 20.6%), compared to PAD-only (Aspirin, 2.9% - 54.4%; Clopidogrel, 0% - 11.9%; VKA 0.9% - 2.4%; NOACs 0.0% - 3.4%; Statins, 1.5%- 56.9%; ACE-inhibitors, 0.9% - 17.2%), respectively. Proportion of PAD patients treated with any cardioprotective medication was greater among those with a history of MI or stroke. Whereas, PAD patients with a history of AF were substantially better treated with VKA and NOACs. Conclusion In this nationwide study, use of cardioprotective medication increased considerably with time, but there remains an underuse of guideline-recommended therapy in patients with PAD. Funding Acknowledgement Type of funding source: None

Abstract 24: Health Status Differences Between Early Invasive and Non Invasive Treatment Strategies in Patients With Peripheral Artery Disease: Insights From Portrait Registry

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Suveen Angraal ◽  
Vittal Hejjaji ◽  
Laith Derbas ◽  
Manesh R Patel ◽  
Jan Heyligers ◽  
...  
Keyword(s):  
Health Status ◽  
Peripheral Artery Disease ◽  
Real World ◽  
Medical Management ◽  
World Health ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Early Revascularization ◽  
Artery Disease

Background: In patients with symptomatic peripheral artery disease (PAD), a key treatment goal is to improve their health status; their symptoms, function, and quality of life (QoL). While medical therapy with lifestyle changes is recommended in all, revascularization can be a consideration to alleviate PAD symptoms. We sought to compare the real-world impact of either treatment strategy on patients’ health status improvement. Methods: Patients with new or worsening PAD symptoms (Rutherford category 1-3), from 10 U.S. specialty vascular clinics between 2011-2015, who either underwent early revascularization (using stent, angioplasty or surgery within 3 months of enrolment) or medical management alone (statin, aspirin, cilostazol, supervised exercise therapy, risk factor (diabetes, hypertension) management) were identified from the Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry. The Peripheral Artery Questionnaire (PAQ) was used to assess patients’ disease-specific health status at enrollment and at 3, 6 and 12 months of follow up. The differences in PAQ overall summary scores, and each subdomain, were compared using an adjusted generalized linear model for repeated measures (Figure 1). Results: Among 797 patients (mean age of 68.6 years, 58.1% male), 226 underwent early revascularization and 571 were managed medically. At baseline, patients in the revascularization vs. medical management cohort had lower PAQ summary scores (mean ± SD; 42.6 ± 20.7 vs. 48.5 ± 22.3, P<0.001) and QoL scores (43.4 ± 23.9 vs. 50.4 ± 26.4, P<0.001). Over 1 year of follow-up, patients who underwent revascularization reported significantly higher health status over time than patients managed medically without revascularization (P <0.001 for all PAQ sub-domains; Figure 1). Conclusion: Patients with PAD who received early revascularization had worse health status at baseline, but they reported a greater degree of improvement over 1 year of follow-up when compared to patients managed medically without revascularization. Summarizing real-world health status benefits following a PAD diagnosis is critical to help guide preference-sensitive decisions on PAD management.

scholarly journals Family History of Peripheral Artery Disease Is Associated With Prevalence and Severity of Peripheral Artery Disease

2011 ◽  
Vol 58 (13) ◽  
pp. 1386-1392 ◽  
Author(s):  
Christina L. Wassel ◽  
Rohit Loomba ◽  
Joachim H. Ix ◽  
Matthew A. Allison ◽  
Julie O. Denenberg ◽  
...  
Keyword(s):  
Family History ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease

scholarly journals Association of perceived stress with health status outcomes in patients with peripheral artery disease

2021 ◽  
Vol 140 ◽  
pp. 110313
Author(s):  
Ali O. Malik ◽  
Poghni Peri-Okonny ◽  
Kensey Gosch ◽  
Merrill B. Thomas ◽  
Carlos Mena-Hurtado ◽  
...  
Keyword(s):  
Health Status ◽  
Peripheral Artery Disease ◽  
Perceived Stress ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Relationship Between Depressive Symptoms and Health Status in Peripheral Artery Disease: Role of Sex Differences

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Qurat‐ul‐ain Jelani ◽  
Carlos Mena‐Hurtado ◽  
Matthew Burg ◽  
Robert Soufer ◽  
Kensey Gosch ◽  
...  
Keyword(s):  
Sex Differences ◽  
Depressive Symptoms ◽  
Health Status ◽  
Visual Analogue Scale ◽  
Peripheral Artery Disease ◽  
Repeated Measures ◽  
Analogue Scale ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Disease Specific

Background The association of depressive symptoms with health status in peripheral artery disease (PAD) is understudied. No reports of differential impact on women have been described. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Artery Disease Investigating Trajectories) registry enrolled 1243 patients from vascular specialty clinics with new or worsening PAD symptoms. Depressive symptoms were assessed at baseline and 3 months using the 8‐Item Patient Health Questionnaire (score ≥10 indicating clinically relevant depressive symptoms). Disease‐specific and generic health status were measured by Peripheral Artery Questionnaire and EQ‐5D Visual Analogue Scale at baseline and 3, 6, and 12 months. An adjusted general linear model for repeated measures was constructed for baseline and 3‐, 6‐, and 12‐month health status outcomes by depressive symptoms at baseline. Differences by sex were tested with interaction effects. The mean age was 67.6±9.4 years with 38% (n=470) women. More women than men (21.1% versus 12.9%; P <0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all P <0.0001). Results were similar for EQ‐5D Visual Analogue Scale scores. The magnitude in 1‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in 1‐year Peripheral Artery Questionnaire summary scores. Conclusions Women with PAD have a high burden of depressive symptoms. Depressive symptoms were associated with a strikingly worse disease‐specific health status recovery path over the year following PAD diagnosis in men and women. Developing and testing interventions to address depressive symptoms in PAD are urgently needed. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01419080.

scholarly journals Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association

Circulation ◽  
2019 ◽  
Vol 140 (13) ◽  
Author(s):  
Diane Treat-Jacobson ◽  
Mary M. McDermott ◽  
Joshua A. Beckman ◽  
Marsha A. Burt ◽  
Mark A. Creager ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Outcome Measurement ◽  
The United States ◽  
Walking Ability ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Artery Disease

Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.

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