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(Circulation. 2007;115:569-575.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Quantifying Improvement in Symptoms, Functioning, and Quality of Life After Peripheral Endovascular Revascularization

David M. Safley, MD; John A. House, MS; Steven B. Laster, MD; William C. Daniel, MD; John A. Spertus, MD, MPH; Steven P. Marso, MD

From Mid America Heart Institute, St Luke’s Hospital (D.M.S., J.A.H., S.B.L., W.C.D., J.A.S., S.P.M.), and University of Missouri (D.M.S., S.B.L., W.C.D., J.A.S., S.P.M.), Kansas City, Mo.

Correspondence to Steven P. Marso, MD, Clinical Scholar, Mid America Heart Institute, Associate Professor of Medicine, University of Missouri–Kansas City, 4401 Wornall Rd, Kansas City, MO 64111. E-mail smarso{at}saint-lukes.org

Received June 5, 2006; accepted December 4, 2006.

Background— Patients with peripheral arterial disease often undergo peripheral endovascular revascularization (PER) to alleviate symptoms. Despite the growth of PER, little information exists quantifying the health status benefits after the procedure.

Methods and Results— From February 2001 to August 2004, 477 consecutive patients underwent PER for symptomatic peripheral arterial disease. Of these, 300 consented to participate in a longitudinal follow-up study of their health status. Health status was quantified with the disease-specific Peripheral Artery Questionnaire and the generic Short Form-12 and the EuroQol 5 Dimensions (EQ5D)questionnaire. Scores range from 0 to 100; higher scores represent fewer symptoms and better health status. The average age of the cohort was 68±11 years (mean±SD); 186 (62%) were male, 288 (96%) were white, and 118 (39%) were diabetic. Clinical follow-up was attained in 99% of patients; health status assessments were made in 86%. Mean Peripheral Artery Questionnaire summary scores improved significantly after revascularization from 31±19 to 62±27 at 1 year (P<0.0001). Generic health status scores also improved significantly (P<0.001 for all). Despite a technically successful procedure in 98% of patients, 21% of patients did not achieve the minimal clinically important improvement of an 8-point change in Peripheral Artery Questionnaire Summary score after PER (35±19 at baseline versus 31±16 at 1 year; P=0.09).

Conclusions— For most patients, significant and sustained improvements in symptoms, functioning, and quality of life occur after PER. Identifying and counseling patients less likely to benefit from PER is an important future research direction.

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CLINICAL PERSPECTIVE

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