ABSTRACT
OBJECTIVE/BACKGROUND: Limited information is available on expected health status gains following invasive treatment in peripheral arterial disease (PAD). One year health status outcomes following invasive treatment for PAD were compared, and whether pre-procedural health status was indicative of 1 year health status gains was evaluated. METHODS: Pre-procedural and 1 year health status (Short Form-12, Physical Component Score [PCS]) was prospectively assessed in a cohort of 474 patients, enrolled from 2 Dutch vascular clinics (March 2006-August 2011), with new or exacerbation of PAD symptoms. One year treatment strategy (invasive vs. non-invasive) and clinical information was abstracted. Quartiles of baseline health status scores and mean 1 year health status change scores were compared by invasive treatment for PAD. The numbers needed to treat (NNT) to obtain clinically relevant changes in 1 year health status were calculated. A propensity weight adjusted linear regression analysis was constructed to predict 1 year PCS scores. RESULTS: Invasive treatment was performed in 39% of patients. Patients with baseline health status scores in the lowest quartile undergoing invasive treatment had the greatest improvement (mean invasive 11.3 ± 10.3 vs. mean non-invasive 5.3 ± 8.5 [p = .001, NNT = 3]), whereas those in the highest quartile improved less (.8 ± 6.3 vs. -3.0 ± 8.2 [p = .025, NNT = 90]). Undergoing invasive treatment (p < .0001) and lower baseline health status scores (p < .0001) were independently associated with greater 1 year health status gains. CONCLUSION: Substantial improvements were found in patients presenting with lower pre-procedural health status scores, whereas patients with higher starting health status levels had less to gain by an invasive strategy.
Subject(s)
Health Status Indicators , Health Status , Peripheral Arterial Disease/therapy , Aged , Disease Progression , Female , Humans , Linear Models , Male , Mental Health , Middle Aged , Netherlands , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/psychology , Predictive Value of Tests , Propensity Score , Prospective Studies , Recovery of Function , Risk Factors , Severity of Illness Index , Time Factors , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
OBJECTIVES: To obtain Western European perspectives on the economic burden of atherothrombosis in patients with multiple risk factors only (MRF), cerebrovascular disease (CVD), coronary artery disease (CAD), and in the under-evaluated group of patients with peripheral arterial disease (PAD), we examined vascular-related hospitalisation rates and associated costs in France and Germany. DESIGN: The prospective REACH Registry enrolled 4693 patients in France, and 5594 patients in Germany (from December 2003 until June 2004). METHODS: For each country, 2-year rates and costs associated with cardiovascular events and vascular-related hospitalisations were examined for patients with MRF, CVD, CAD, and PAD. RESULTS: Two-year hospitalisation costs were highest for patients with PAD (3182.1 for France; 2724.4 for Germany) and lowest for the MRF group (749.1 for France; 503.3 for Germany). Peripheral revascularizations and amputations were the greatest contributors to costs for all risk groups. Across all PAD subgroups, peripheral procedures constituted approximately half of the 2-year costs. CONCLUSION: Hospitalisation rates and costs associated with atherothrombotic disease in France and Germany are high, especially so for patients with PAD.
Subject(s)
Cerebrovascular Disorders/economics , Coronary Artery Disease/economics , Health Care Costs , Hospitalization/statistics & numerical data , Peripheral Arterial Disease/economics , Thrombosis/economics , Aged , Aged, 80 and over , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/surgery , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Cost of Illness , Female , Follow-Up Studies , France , Germany , Humans , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/surgery , Prospective Studies , Registries , Risk Factors , Thrombosis/etiologyABSTRACT
OBJECTIVES: Peripheral arterial disease (PAD) is associated with adverse cardiovascular events and can significantly impair patients' health status. Recently, marked methodological improvements in the measurement of PAD patients' health status have been made. The Peripheral Artery Questionnaire (PAQ) was specifically developed for this purpose. We validated a Dutch version of the PAQ in a large sample of PAD patients. DESIGN: Cross-sectional study. METHODS: The Dutch PAQ was completed by 465 PAD patients (70% men, mean age 65+/-10 years) participating in the Euro Heart Survey Programme. Principal components analysis and reliability analyses were performed. Convergent validity was documented by comparing the PAQ with EQ-5D scales. RESULTS: Three factors were discerned; Physical Function, Perceived Disability, and Treatment Satisfaction (factor loadings between 0.50 and 0.90). Cronbach's alpha values were excellent (mean alpha=0.94). Shared variance of the PAQ domains with EQ-5D scales ranged from 3 to 50%. CONCLUSIONS: The Dutch PAQ proved to have good measurement qualities; assessment of Physical Function, Perceived Disability, and Treatment Satisfaction facilitates the monitoring of patients' perceived health in clinical research and practice. Measuring disease-specific health status in a reliable way becomes essential in times were a wide array of treatment options are available for PAD patients.