Association of Disease-Specific Health Status With Long-Term Survival in Peripheral Artery Disease

Abstract

Background While peripheral artery disease (PAD) is associated with increased cardiovascular morbidity with mortality remaining high and challenging to predict, accurate understanding of serial PAD-specific health status around the time of diagnosis may prognosticate long-term mortality risk. Methods and Results Patients with new or worsening PAD symptoms enrolled in the PORTRAIT Registry across 10 US sites from 2011 to 2015 were included. Health status was assessed by the Peripheral Artery Questionnaire (PAQ) Summary score at baseline, 3-month, and change from baseline to 3-month follow-up. Kaplan-Meier using 3-month landmark and hierarchical Cox regression models were constructed to assess the association of the PAQ with 5-year all-cause mortality. Of the 711 patients (mean age 68.8±9.6 years, 40.9% female, 72.7% white; mean PAQ 47.5±22.0 and 65.9±25.0 at baseline and 3-month, respectively), 141 (19.8%) died over a median follow-up of 4.1 years. In unadjusted models, baseline (HR, 0.90 per-10-point increment; 95% CI, 0.84-0.97; P=0.008), 3-month (HR [95% CI], 0.87 [0.82-0.93]; P<0.001) and change in PAQ (HR [95% CI], 0.92 [0.85-0.99]; P=0.021) were each associated with mortality. In fully adjusted models including combination of scores, 3-month PAQ was more strongly associated with mortality than either baseline (3-month HR [95% CI], 0.85 [0.78-0.92]; P<0.001; C-statistic, 0.77) or change (3-month HR [95% CI], 0.79 [0.72-0.87]; P<0.001). Conclusions PAD-specific health status is independently associated with 5-year survival in patients with new or worsening PAD symptoms, with the most recent assessment being most prognostic. Future work is needed to better understand how this information can be used proactively to optimize care.

Keywords: health status; mortality; peripheral artery disease.

Figure 1. STROBE diagram of the study cohort.

PAQ indicates Peripheral Artery Questionnaire; PORTRAIT, Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories; and STROBE, Strengthening the Reporting of Observational Studies in Epidemiology.

Figure 2. Mortality rates by ranges of Peripheral Artery Questionnaire (PAQ) summary score.

Red dash line indicates total 5‐year all‐cause mortality.

Figure 3. Kaplan‐Meier survival curves by ranges of Peripheral Artery Questionnaire (PAQ) summary score at baseline and 3‐month.

The 5‐year Kaplan‐Meier probability estimate (95% confidence interval) of survival stratified by PAQ groups (0–24, 25–49, 50–74 and 75–100) at (A) baseline is 69.6% (60.5–80.1), 72.2% (64.5–80.8), 84.6% (80.1–89.5), and 75.5% (64.3–88.5) and (B) 3‐month is 68.6% (56.6–83.2), 63.9% (54.9–74.4), 72.6% (63.4–83.0), and 80.7% (74.9–87.0), respectively.