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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.

Publication ,  Journal Article
Rymer, JA; Mulder, H; Smolderen, KG; Hiatt, WR; Conte, MS; Berger, JS; Norgren, L; Mahaffey, KW; Baumgartner, I; Fowkes, FG; Katona, BG ...
Published in: J Am Heart Assoc
October 20, 2020

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.

Duke Scholars

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 20, 2020

Volume

9

Issue

19

Start / End Page

e016573

Location

England

Related Subject Headings

  • Visual Analog Scale
  • Vascular Surgical Procedures
  • Ticagrelor
  • Symptom Assessment
  • Surveys and Questionnaires
  • Quality of Life
  • Platelet Aggregation Inhibitors
  • Peripheral Arterial Disease
  • Outcome Assessment, Health Care
  • Middle Aged
 

Citation

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Rymer, J. A., Mulder, H., Smolderen, K. G., Hiatt, W. R., Conte, M. S., Berger, J. S., … Patel, M. R. (2020). 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. J Am Heart Assoc, 9(19), e016573. https://doi.org/10.1161/JAHA.120.016573
Rymer, Jennifer A., Hillary Mulder, Kim G. Smolderen, William R. Hiatt, Michael S. Conte, Jeffrey S. Berger, Lars Norgren, et al. “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.J Am Heart Assoc 9, no. 19 (October 20, 2020): e016573. https://doi.org/10.1161/JAHA.120.016573.
Rymer JA, Mulder H, Smolderen KG, Hiatt WR, Conte MS, Berger JS, Norgren L, Mahaffey KW, Baumgartner I, Fowkes FG, Katona BG, Rockhold F, Jones WS, Patel MR. 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. J Am Heart Assoc. 2020 Oct 20;9(19):e016573.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

October 20, 2020

Volume

9

Issue

19

Start / End Page

e016573

Location

England

Related Subject Headings

  • Visual Analog Scale
  • Vascular Surgical Procedures
  • Ticagrelor
  • Symptom Assessment
  • Surveys and Questionnaires
  • Quality of Life
  • Platelet Aggregation Inhibitors
  • Peripheral Arterial Disease
  • Outcome Assessment, Health Care
  • Middle Aged