Abstract 15674: Walking Impairment Questionnaire Adds Predictive Value for Adverse Cardiac and Limb Events in Patients With Peripheral Arterial Disease
Background: Peripheral arterial disease (PAD) is associated with a high risk of adverse cardiac and limb events. Functional disability confers increased risk of mortality in PAD. Whether functional measures provide clinical utility in predicting lower extremity and cardiac outcomes is not clear.
Methods and Results: We followed 312 PAD patients (65±10 years, 43% women) prospectively over two years for adverse cardiac events (n=48, myocardial infarction, unstable angina, coronary revascularization, transient ischemic event, stroke, congestive heart failure, cardiac death) and adverse limb events (n=71, new or worse intermittent claudication, peripheral revascularization, critical limb ischemia, amputation, graft or stent failure). We assessed functional status using the Walking Impairment Questionnaire and disease severity by the ankle-brachial index (ABI). Lower walking distance score was associated with a higher risk of adverse cardiac events and adverse limb events (Figure). In multivariable models adjusting for age, sex, ABI, and relevant comorbidities, PAD patients with the lowest walking distance scores had higher risk of both adverse cardiac and limb events (HR 3.04, 95% CI 1.67-5.52, p=0.0003 and HR 2.24, 95% CI 1.36-3.66, p=0.0015). When added to the clinical risk factor model, walking distance score improved net risk reclassification for both adverse cardiac and limb events (58%, P<0.001 and 43%, P<0.01).
Conclusions: Impaired walking ability provides additional prognostic value over the ABI for predicting adverse cardiac and limb events in PAD. The addition of a functional evaluation by a simple survey may enhance clinical risk assessment in PAD.
- © 2013 by American Heart Association, Inc.