One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Lifestyle changes and medications are recommended as the first line of treatment for claudication, with revascularization considered for treatment-resistant symptoms, based on patients' preferences. Real-world evidence comparing health status outcomes of early invasive with noninvasive management strategies is lacking. METHODS: In the international multicenter prospective observational PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry, disease-specific health status was assessed by the Peripheral Artery Questionnaire in patients with new-onset or worsening claudication at presentation and 3, 6, and 12 months later. One-year health status trajectories were compared by early revascularization versus noninvasive management on a propensity-matched sample using hierarchical generalized linear models for repeated measures adjusted for baseline health status. RESULTS: In a propensity-matched sample of 1000 patients (67.4±9.3 years, 62.8% male, and 82.4% White), 297 (29.7%) underwent early revascularization and 703 (70.3%) were managed noninvasively. Over 1 year of follow-up, patients who underwent early invasive management reported significantly higher health status than patients managed noninvasively (interaction term for time and treatment strategy; P<0.001 for all Peripheral Artery Questionnaire domains). The average 1-year change in Peripheral Artery Questionnaire summary scores was 30.8±25.2 in those undergoing early invasive, compared with 16.7±23.4 in those treated noninvasively (P<0.001). CONCLUSIONS: Patients with claudication undergoing early invasive treatment had greater health status improvements over the course of 1 year than those treated noninvasively. These data can be used to support shared decision-making with patients. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01419080.

Full Text

Duke Authors

Cited Authors

  • Angraal, S; Hejjaji, V; Tang, Y; Gosch, KL; Patel, MR; Heyligers, J; White, CJ; Tutein Nolthenius, R; Mena-Hurtado, C; Aronow, HD; Moneta, GL; Fitridge, R; Soukas, PA; Abbott, JD; Secemsky, EA; Spertus, JA; Smolderen, KG

Published Date

  • June 2022

Published In

Volume / Issue

  • 15 / 6

Start / End Page

  • e011506 -

PubMed ID

  • 35579010

Electronic International Standard Serial Number (EISSN)

  • 1941-7632

Digital Object Identifier (DOI)

  • 10.1161/CIRCINTERVENTIONS.121.011506


  • eng

Conference Location

  • United States