Abstract 92: One-Year Health Status Benefits Following Invasive Treatment for Lower-Extremity Peripheral Arterial Disease: The Importance of Patients' Baseline Health Status

Abstract

Introduction: The decision-making process for invasive treatment in lower-extremity peripheral arterial disease (PAD) is ambiguous. There is a lack of appropriateness criteria and limited information available on health status gains to be expected following invasive treatment. We compared 1-year health status outcomes by the receipt of invasive treatment among patients with PAD and evaluated whether baseline health status was indicative of the 1-year health status gains, assuming that patients with lower baseline health status scores would receive the highest benefit. Methods: Baseline and 1-year health status (SF-12, Physical Component Score [PCS]) was assessed in 380 patients with newly diagnosed PAD (Rutherford 1-3) enrolled from 2 Dutch vascular clinics (March ‘06-November ’10). The 1-year treatment strategy (invasive [endovascular, surgery] vs. non-invasive [exercise therapy]) and clinical information was abstracted. Mean 1-year health status scores were compared by invasive treatment. Propensity weights were calculated for the receipt of invasive treatment using baseline characteristics and included in a linear regression analysis to predict 1-year PCS scores, with 1-year treatment strategy, baseline PCS scores, and the interaction between 1-year treatment strategy and PCS scores as predictors, while adjusting for demographics, lesion location, clinical risk factors, and depression. Results: Invasive treatment was performed in 38% (192 of 380). Patients with baseline health status scores in the lowest quartile undergoing invasive treatment had the greatest health status improvement (11.6±10.5 vs. 4.2±8.1, P<.0001), whereas those in the highest quartile did not improve significantly, regardless of the treatment strategy (0.1±6.3 vs. -2.5±8.4, P=.17) (Figure). One-year invasive treatment (B=5.51; 95%CI 0.55;10.48; P=.03) and lower baseline health status scores (B=-.44; 95%CI -.57;-.33; P<.0001) were independently associated with greater 1-year health status gains. The interaction with baseline health status and treatment strategy failed to reach significance (P=.36). Conclusions: Although invasive treatment in lower-extremity PAD is associated with clinically relevant 1-year health status benefits, we found that patients with lower starting levels of their health status had more to gain. Whether or not this will imply that only patients below a certain health status threshold should be offered invasive treatment needs to be subject of further research.