Abstract
PurposeTo determine the effect of revascularisation for peripheral arterial disease (PAD) on QoL in the first and second year following diagnosis, to compare the effect depicted by Short Form Six Dimensions (SF-6D) and EuroQoL five Dimensions (EQ-5D) utilities, and Visual Analogue Scale (VAS) scores and to analyse heterogeneity in treatment response.MethodsLongitudinal data from 229 PAD patients were obtained in an observational study in southern Netherlands. Utility scores were calculated with the international (SF-6D) and Dutch (EQ-5D) tariffs. We analysed treatment effect at years 1 and 2 through propensity score-matched ANCOVAs. Thereby, we estimated the marginal means (EMMs) of revascularisation and conservative treatment, and identified covariates of revascularisation effect.ResultsA year after diagnosis, 70 patients had been revascularised; the EMMs of revascularisation were 0.038, 0.077 and 0.019 for SF-6D, EQ-5D and VAS, respectively (always in this order). For conservative treatment these were − 0.017, 0.038 and 0.021. At 2-year follow-up, the EMMs of revascularisation were 0.015, 0.077 and 0.027, for conservative treatment these were − 0.020, 0.013 and − 0.004. Baseline QoL (and rest pain in year 2) were covariates of treatment effect.ConclusionsWe measured positive effects of revascularisation and conservative treatment on QoL a year after diagnosis, the effect of revascularisation was sustained over 2 years. The magnitude of effect varied between the metrics and was largest for the EQ-5D, which may be most suitable for QoL measurement in PAD patients. Baseline QoL influenced revascularisation effect, in clinical practice this may inform expected QoL gain in individual patients.
Highlights
Peripheral arterial disease (PAD) is a chronic disease, characterised by the atherosclerotic narrowing of the lower extremity arteries [1]
After exclusion of 56 patients for completely missing quality of life (QoL) measurements, the population analysed consisted of 229 PAD patients
At 1-year follow-up, 70 patients (30.6%) had received revascularisation, and no relationship was detected between time since revascularisation and change in QoL at year 1
Summary
Peripheral arterial disease (PAD) is a chronic disease, characterised by the atherosclerotic narrowing of the lower extremity arteries [1]. Peripheral revascularisation, the open- or endovascular restoring of blood flow in the legs, (f.i. angioplasty, bypass surgery), is typically applied for acute limb ischemia or disease progression. Studies showed that 6 months after revascularisation, mean EuroQoL five Dimensions (EQ-5D) utilities increased, stagnated during the following year [8]; 4 years after revascularisation, pain was the only Nottingham health profile domain significantly improved [9]. This calls into question the sustainability of the effect of revascularisation on QoL
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