One year health status benefits following treatment for new onset or exacerbation of peripheral arterial disease symptoms: the importance of patients' baseline health status

M van Zitteren; J Denollet; J M Heyligers; J W M Elshof; M J Nooren; D H Burger; W M de Fijter; P W Vriens; K G Smolderen

doi:10.1016/j.ejvs.2015.04.003

One year health status benefits following treatment for new onset or exacerbation of peripheral arterial disease symptoms: the importance of patients' baseline health status

Eur J Vasc Endovasc Surg. 2015 Aug;50(2):213-22. doi: 10.1016/j.ejvs.2015.04.003. Epub 2015 May 30.

Authors

M van Zitteren¹, J Denollet², J M Heyligers³, J W M Elshof³, M J Nooren³, D H Burger³, W M de Fijter⁴, P W Vriens³, K G Smolderen⁵

Affiliations

¹ Center of Research on Psychology in Somatic Diseases, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands; St. Elisabeth Hospital, Department of Vascular Surgery, PO Box 90151, 5000 LC, Tilburg, The Netherlands.
² Center of Research on Psychology in Somatic Diseases, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
³ St. Elisabeth Hospital, Department of Vascular Surgery, PO Box 90151, 5000 LC, Tilburg, The Netherlands.
⁴ TweeSteden Hospital, Department of Vascular Surgery, Tilburg, The Netherlands.
⁵ Center of Research on Psychology in Somatic Diseases, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands; UMKC School of Medicine; Biomedical & Health Informatics, 1000 E24th Street, 5th Floor, Kansas City, MO, 64108, USA. Electronic address: smolderenk@umkc.edu.

PMID: 26036809
DOI: 10.1016/j.ejvs.2015.04.003

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.

Keywords: Atherosclerosis; Peripheral vascular disease; Revascularization.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Disease Progression
Female
Health Status Indicators*
Health Status*
Humans
Linear Models
Male
Mental Health
Middle Aged
Netherlands
Peripheral Arterial Disease / diagnosis
Peripheral Arterial Disease / physiopathology
Peripheral Arterial Disease / psychology
Peripheral Arterial Disease / therapy*
Predictive Value of Tests
Propensity Score
Prospective Studies
Recovery of Function
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex