Abstract

OBJECTIVE: Patient-reported outcomes (PRO) are increasingly emphasized for peripheral artery disease (PAD). Patient-defined treatment goals and expectations, however, are poorly understood and may not be achievable or aligned with guidelines or traditional outcomes. We evaluated patient-reported treatment goals among patients with claudication and associations between patient characteristics, goals, and PAD-specific PRO scores.METHODS: Patients diagnosed with claudication were prospectively recruited. Patient-defined treatment goals and outcomes related to walking distance, duration, and speed were quantified using multiple choice survey items. Free-text items were used to identify activities other than walking distance, duration or speed associated with PAD symptoms and treatment goals. The Peripheral Artery Disease Quality of Life (PADQOL) and Walking Impairment Questionnaire (WIQ) instruments were included as PRO. Treatment goal categories were compared with PRO percentile scores using confidence intervals, categorical tests, and logistic regression models. Associations between patient characteristics and PRO were evaluated using linear and ordinal logistic regression models.RESULTS: 150 patients meeting the inclusion criteria participated; of these, 144 (96%) viewed the entire survey. Mean age was 70.0±11.3 years, and 32.9% were women. The majority of respondents self-reported race as white (N=135), followed by Black (N=3), Asian (N=2), American Indian (N=2) and other/unknown (N=2). Two participants self-reported Hispanic ethnicity. Primary treatment goals were: increased walking distance or duration without stopping (62.0%), ability to perform a specific activity or task (23.0%), increased walking speed (8.0%), or other/none of the above (7.0%). Specific activities associated with symptoms or goals included: outdoor recreation (38.5%), labor-related tasks (30.7%), sports (26.9%), climbing stairs (23.1%), uphill walking (19.2%), and shopping (6%). Among patients choosing increased walking distance and duration as primary goals, 64% indicated a distance =0.5 miles (2640 feet) and 59% indicated a duration = 30 minutes as minimum increases consistent with meaningful improvement. Increasing age was associated with lower odds of a distance improvement goal = 0.5 miles (OR 0.68 per 5 years; 95% CL 0.51-0.92; P=0.012) or duration improvement goal = 30 minutes (OR 0.76 per 5-years; 95% CL 0.58-0.99; P=0.047). Patient characteristics associated with PADQOL percentile scores included age, ABI, and gender. ABI was the only patient characteristic associated with WIQ percentile scores.CONCLUSIONS: Patients define treatment goals based on activities and expectations that may influence perceived outcomes. Minimum walking distance and duration increases consistent with meaningful improvement exceed published minimum important difference criteria for many patients and would be uncaptured using common clinic-based walking tests. Patient age is associated with both treatment goals and PRO scores, and related floor and ceiling effects may influence sensitivity to PRO change among older and younger patients. Heterogeneity in treatment goals supports consideration of tailored approaches informed by patient characteristics and perspectives regarding treatment success versus failure.

View details for DOI 10.1016/j.jvs.2022.09.002

View details for PubMedID 36087833