Functional Health and Well-Being in Patients With Severe Atherosclerotic Peripheral Vascular Occlusive Disease

Abstract

Functional health and sense of well-being are known to be adversely affected by chronic illness. The extent to which peripheral vascular occlusive disease (PVOD) alters these factors independent of other comorbid conditions is unknown. Sixty patients with PVOD severe enough to have required aortobifemoral bypass (AFB) between 1985 and 1990 were selected for evaluation. Although all were heavy smokers and 20% had suffered previous myocardial infarction, all had adequate cardiopulmonary function to survive AFB. The SF-20 questionnaire, validated in the Medical Outcomes Study (MOS), was used to evaluate patients' functional health and well-being at least 6 months after AFB. All grafts were patent at the time of questionnaire completion. Three measures of functional health (physical function, role function, and bodily pain) and three measures of well-being (mental health, health perception, and social function) were scored from SF-20 responses using the MOS protocol. These PVOD patients were then compared to MOS norms for patients without any chronic disease, to MOS norms adjusted for age and other comorbidities of the PVOD patients sampled, and to patients with congestive heart failure or recent myocardial infarction. Physical function, role function, and health perception were worse and bodily pain greater in patients with severe PVOD after surgical treatment as compared with MOS patients even after adjustment for comorbidities. Decrements in physical function, role function, and health perception for PVOD patients were comparable to MOS patients with congestive heart failure or recent myocardial infarction, whereas level of bodily pain was worse in PVOD patients than in these other groups. After adjustment for comorbidities, social function and mental health were not independently affected by PVOD. Functional health and well-being were not significantly different when PVOD patients with limb threat were compared to those with claudication. Severe PVOD is associated with decrements in functional health and well-being comparable to or greater than other severe chronic illness, even after successful revascularization. Further study is needed to examine the effect of revascularization on functional health.