Risk attitudes to treatment among patients with severe intermittent claudication

NewsBot · Jun 13, 2008

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Risk attitudes to treatment among patients with severe intermittent claudication.
Letterstål A, Forsberg C, Olofsson P, Wahlberg E.
J Vasc Surg. 2008 May;47(5):988-94.

OBJECTIVES: To determine claudication patients' risk attitude to invasive treatment and whether this treatment is cost effective.

METHODS: Quality of life and health state utility status of 50 consecutive patients with severe intermittent claudication was assessed and compared with ankle-brachial pressure index values (ABPI) and results from treadmill tests before and after endovascular or open revascularization. Health utility scores were then calculated and used in a cost-utility analysis.

RESULTS: Before surgery, patients were assigned a utility score of 0.51 (EQ-5D index) for their disease, and the standard gamble (SG) and time trade-off (TTO) median scores were 0.88 and 0.70, respectively. Before treatment, a weak correlation (r = 0.43, P < .001) between having a high risk perception of treatment and patients' walking distance were observed, where patients able to walk short distances accepted a higher risk. After treatment, ABI (P = .003) and walking distance (P = .002) improved significantly as well the physical components of the quality of life instruments (P < .001). The surgical treatment generated an improvement in quality of life expressed in QALYs equivalent to 0.17. With an estimated survival of 5 years, it adds up to a value of 0.85, corresponding to a sum of 51,000 US dollars gained.

CONCLUSIONS: Patients with severe intermittent claudication are risk-seeking when it comes to surgical treatment and their risk attitude is correlated to their walking ability and quality of life. The incremental QALYs gained by treatment are achieved at a reasonable cost and revascularization appears to be cost effective.
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NewsBot · Aug 16, 2008

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program.
Regensteiner JG, Hiatt WR, Coll JR, Criqui MH, Treat-Jacobson D, McDermott MM, Hirsch AT.
Vasc Med. 2008 Feb;13(1):15-24.

This study tested the hypothesis that patients with PAD have impaired health-related quality of life (HRQoL) to a degree similar to that of patients with other types of cardiovascular disease (other-CVD), and also evaluated the clinical features of PAD associated with impaired HRQoL. This was a cross-sectional study in 350 primary care practice sites nationwide with 6,499 participants. The reference group had no clinical or hemodynamic evidence of PAD or other-CVD; the PAD group had an ankle-brachial index < 0.90 or a prior history of PAD; the other-CVD group had a clinical history of cardiac or cerebral vascular disease (but no PAD), and the combined PAD-other-CVD group included both diagnoses. Individuals were assessed using four HRQoL questionnaires including the Walking Impairment Questionnaire (WIQ), Medical Outcomes Study SF-36 (SF-36), Cantril Ladder of Life and the PAD Quality of Life questionnaire. PAD patients had lower WIQ distance scores than the other-CVD group. Both the PAD and other-CVD groups had significantly lower SF-36 Physical Function scores compared with the reference group. The WIQ revealed that PAD patients were more limited by calf pain, whereas other-CVD patients were more limited by chest pain, shortness of breath and palpitations. In conclusion, in this nationwide study, one of the first to directly compare the HRQoL burden of CVD with that of PAD, the evaluation of PAD in office practice revealed a HRQoL burden as great in magnitude as in patients with other forms of CVD.
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NewsBot · Apr 25, 2012

Press release:
Depression linked to greater risk of peripheral artery disease
April 20, 2012

Depression linked to greater risk of peripheral artery disease
Depression may be associated with an increased risk of arterial narrowing in the legs and pelvis, a condition known as peripheral artery disease External link (PAD), according to research presented at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology 2012 Scientific Sessions in Chicago.

While experts know that depression is a risk factor for constricted heart arteries, its effect on PAD is uncertain. Researchers used data from 1,024 men and women in the Heart and Soul Study and followed them for about seven years.

At the study’s start, 12 percent of participants with depression had PAD, compared to seven percent of patients without depression who had PAD. Similarly, nine percent of depressed patients and six percent of those without depression had PAD-related events during the seven-year follow-up.

These findings demonstrate the importance of depression screening External link and treatment for PAD patients, according to the researchers.
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