Abstract
Background: The aging population along with the increased use of statins, anti-platelet agents, supervised exercise (SE) and smoking cessation (SC) may be altering the epidemiology of peripheral arterial disease (PAD) and may be delaying its onset. There are no insights into how older versus younger patients differ in terms of PAD severity, risk profiles, health status and treatment. We hypothesized that in the absence of any reliable age-related differences in treatment effectiveness, that risk reduction and revascularization would be used equally across PAD age cohorts. Aim: Assess age-specific differences in baseline characteristics, PAD-specific health status, and patterns of care in patients in the PORTRAIT registry. Methods: The PORTRAIT registry prospectively collected data from 1275 patients with new or worsening PAD symptoms who were treated in the US, the Netherlands or Australia between June 2011 and October 2015. Patients were grouped by age (< 60 years, 60 to ≤75 years, and > 75 years). We compared patient characteristics at the point of seeking specialty PAD care, including severity of PAD (Rutherford classification); health status assessed by the Peripheral Artery (PAQ) and EuroQol five dimensions (EQ5D) questionnaires; and subsequent clinical care offered for PAD, including statins, anti-platelet agents, SE, and SC. The use of revascularization (surgical or endovascular) was assessed at 3 months. Continuous variables were compared using the linear trend test. Categorical variables were compared using Mantel-Haenszel trend test. Results: There were 303 patients < 60 years (mean 55.0 ± 4.3), 675 patients 60 to ≤75 years (mean 67.8 ± 3.9), and 297 patients ≥ 75 years (mean 79.9 ± 4.1). There were no differences in baseline ABI (mean 0.66 ± 0.2, p=0.44) or Rutherford classification (p=0.47). PAQ summary, quality of life, social limitation, and symptom scores as well as EQ5D scores were significantly worse in patients < 60 years (p<0.001 for all indicators). Patients < 60 years were more likely to be current smokers (60.9% vs. 35.4%, vs. 17.5%, p<0.001). Risk reduction and quality of life (QOL) improvement PAD treatments that were comparable across age cohorts included: statins (p=0.10), SC (0.17), and referral for invasive therapy (p=0.34). In contrast, SE was prescribed more in patients < 60 years (p< 0.001) while anti-platelet therapy was used less often in this group (p=0.025). Conclusion: These data demonstrate that younger patients are characterized by worse PAD-specific health status at the time of entry into vascular specialty care and that there are age-related disparities in the prescription of PAD risk reduction and QOL improvement therapies. These data cannot document the reasons for these differences. Future quality improvement initiatives might focus on these disparities in presentation and care to improve outcomes in PAD.
Published Version
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