Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial
Background There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Us...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.016573 |
| _version_ | 1819175054859042816 |
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| author | Jennifer A. Rymer Hillary Mulder Kim G. Smolderen William R. Hiatt Michael S. Conte Jeffrey S. Berger Lars Norgren Kenneth W. Mahaffey Iris Baumgartner F. Gerry Fowkes Brian G. Katona Frank Rockhold W. Schuyler Jones Manesh R. Patel |
| author_facet | Jennifer A. Rymer Hillary Mulder Kim G. Smolderen William R. Hiatt Michael S. Conte Jeffrey S. Berger Lars Norgren Kenneth W. Mahaffey Iris Baumgartner F. Gerry Fowkes Brian G. Katona Frank Rockhold W. Schuyler Jones Manesh R. Patel |
| author_sort | Jennifer A. Rymer |
| collection | DOAJ |
| description | Background There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) trial, we examined the characteristics of 13 801 patients by tertile of health status instrument scores collected in the trial (EuroQol 5‐Dimensions [EQ‐5D], EQ visual analog scale [VAS], and peripheral artery questionnaire). We assessed the association between the baseline health status measurements and major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization procedures during trial follow‐up and the association between 12‐month health status change scores and subsequent end points during follow‐up. There were 13 217 (95%) patients with EQ‐5D scores, 13 533 (98%) with VAS scores, and 4431 (32%) with peripheral artery questionnaire scores. Patients in the lowest baseline EQ‐5D tertile (0 to <0.69) were more likely to be female with severe claudication compared with the highest tertile (0.79–1.0; P<0.01). Patients in the lowest VAS (0–60) and peripheral artery questionnaire (0–49) tertiles had lower ankle–brachial indices compared with the highest tertiles (80–100 and 76–108, respectively; P<0.01). There was a significant association between baseline EQ‐5D, VAS, and peripheral artery questionnaire scores and adjusted major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization (P<0.05). Improved EQ‐5D and VAS scores over 12 months were associated with reduced risk of subsequent major adverse cardiovascular events or lower‐extremity revascularization (all P<0.01). Conclusions Although health status instruments are rarely used in clinical practice, these measures are associated with outcomes, including major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization. Further research is needed to determine the relationship between changes in these instruments, revascularization, and outcomes. |
| first_indexed | 2024-12-22T20:48:46Z |
| format | Article |
| id | doaj.art-e411e8d33b9541509abb9cfa16cf2cf4 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:48:46Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e411e8d33b9541509abb9cfa16cf2cf42022-12-21T18:13:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-10-0191910.1161/JAHA.120.016573Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) TrialJennifer A. Rymer0Hillary Mulder1Kim G. Smolderen2William R. Hiatt3Michael S. Conte4Jeffrey S. Berger5Lars Norgren6Kenneth W. Mahaffey7Iris Baumgartner8F. Gerry Fowkes9Brian G. Katona10Frank Rockhold11W. Schuyler Jones12Manesh R. Patel13Division of Cardiology Duke University Medical Center Durham NCDuke Clinical Research Institute Durham NCVascular Medicine Outcomes Program Yale University New Haven CTDivision of Cardiology and Colorado Prevention Center University of Colorado School of Medicine Aurora CODivision of Vascular Surgery University of California San Francisco San Francisco CADivision of Cardiology NYU Langone Health New York NYFaculty of Medicine and Health Orebro University Orebro SwedenStanford Center for Clinical Research Stanford University School of Medicine Stanford CASwiss Cardiovascular Center Inselspital Bern University Hospital University of Bern SwitzerlandUsher Institute of Population Health Sciences and Informatics University of Edinburgh United KingdomAstraZeneca Gaithersburg MDDuke Clinical Research Institute Durham NCDivision of Cardiology Duke University Medical Center Durham NCDivision of Cardiology Duke University Medical Center Durham NCBackground There are limited data on health status instruments in patients with peripheral artery disease and cardiovascular and limb events. We evaluated the relationship between health status changes and cardiovascular and limb events. Methods and Results In an analysis of the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) trial, we examined the characteristics of 13 801 patients by tertile of health status instrument scores collected in the trial (EuroQol 5‐Dimensions [EQ‐5D], EQ visual analog scale [VAS], and peripheral artery questionnaire). We assessed the association between the baseline health status measurements and major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization procedures during trial follow‐up and the association between 12‐month health status change scores and subsequent end points during follow‐up. There were 13 217 (95%) patients with EQ‐5D scores, 13 533 (98%) with VAS scores, and 4431 (32%) with peripheral artery questionnaire scores. Patients in the lowest baseline EQ‐5D tertile (0 to <0.69) were more likely to be female with severe claudication compared with the highest tertile (0.79–1.0; P<0.01). Patients in the lowest VAS (0–60) and peripheral artery questionnaire (0–49) tertiles had lower ankle–brachial indices compared with the highest tertiles (80–100 and 76–108, respectively; P<0.01). There was a significant association between baseline EQ‐5D, VAS, and peripheral artery questionnaire scores and adjusted major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization (P<0.05). Improved EQ‐5D and VAS scores over 12 months were associated with reduced risk of subsequent major adverse cardiovascular events or lower‐extremity revascularization (all P<0.01). Conclusions Although health status instruments are rarely used in clinical practice, these measures are associated with outcomes, including major adverse cardiovascular events, major adverse limb events, and lower‐extremity revascularization. Further research is needed to determine the relationship between changes in these instruments, revascularization, and outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.120.016573health status instrumentsperipheral artery diseasequality of life |
| spellingShingle | Jennifer A. Rymer Hillary Mulder Kim G. Smolderen William R. Hiatt Michael S. Conte Jeffrey S. Berger Lars Norgren Kenneth W. Mahaffey Iris Baumgartner F. Gerry Fowkes Brian G. Katona Frank Rockhold W. Schuyler Jones Manesh R. Patel Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease health status instruments peripheral artery disease quality of life |
| title | Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial |
| title_full | Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial |
| title_fullStr | Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial |
| title_full_unstemmed | Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial |
| title_short | Association of Health Status Scores With Cardiovascular and Limb Outcomes in Patients With Symptomatic Peripheral Artery Disease: Insights From the EUCLID (Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease) Trial |
| title_sort | association of health status scores with cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease insights from the euclid examining use of ticagrelor in symptomatic peripheral artery disease trial |
| topic | health status instruments peripheral artery disease quality of life |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016573 |
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