Abstract 18984: Patterns and Predictors of Invasive Treatment Referral in Peripheral Artery Disease: Insights From the PORTRAIT Study
Introduction: In patients with lifestyle limiting PAD symptoms, practice guidelines support invasive treatment after inadequate response to medical treatment, including exercise therapy and in those with inflow disease, primary invasive treatment can sometimes be used. However, treatment patterns and determinants of invasive treatment allocation in a real world setting are unknown.
Methods: In 1144 patients with new or an exacerbation of PAD symptoms enrolled from 16 international PAD specialty clinics (June 2011-September 2015), we examined invasive (endovascular/surgical) treatment rates ordered during the initial 3 months of care. A hierarchical logistic regression model identified predictors of invasive treatment. Candidate predictors (demographics, socio-economic, PAD severity, type of diagnostic test, clinical history, prior treatment, and psychosocial information) were selected based on clinical importance and random forest analysis (RFA).
Results: 20% patients received invasive treatment (range 9-52%, P likelihood <0.001; 30% with inflow [iliac] and 25% with outflow [femoral/popliteal] disease). Of the 46 candidates, the 5 most important predictors for invasive treatment per RFA were history of direct anatomic visualization (angiogram, CTA, MRA), Rutherford category, PAD specific health status (PAQ summary score), depressive symptoms (PHQ-8 score) and surgical treatment history for PAD. In the final model, a more severe Rutherford category, both proximal and distal lesions and history of direct anatomic visualization were more likely to be associated with invasive treatment, and higher ABI values and better functioning (higher PAQ scores) were less likely to be associated with invasive treatment (Figure).
Conclusions: About 1/5th of patients with new or an exacerbation of PAD symptoms received invasive treatment with wide site variations. Patients with a higher PAD disease burden were preferentially invasively treated.
- Peripheral artery disease (PAD)
- Endovascular Therapy
- Surgical Revascularization
- Quality of medical care
Author Disclosures: Y. Pokharel: Other Research Support; Significant; supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837. Other; Significant; Research reported in this work was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CE-1304-6677). J. Wang: None. W. Hiatt: Research Grant; Significant; Research grant awards to CPC Clinical Research (an affiliate of the University of Colorado) for clinical trials in peripheral artery disease from Bayer, AstraZeneca, Pluristem, NIH, Kyushu university. D. Safley: None. M. Friedell: None. J. Spertus: Research Grant; Significant; Eli Lilly. Ownership Interest; Significant; Co-own the copyright to the PAQ questionnaire. Other; Significant; The primary investigator of a contract from the ACCF to analyze the NCDR data. An equity interest in Health Outcomes Sciences.. K. Smolderen: None.
- © 2016 by American Heart Association, Inc.