Symptoms, Quality of Life Important to Guide Treatment of Peripheral Arterial Disease (PAD)

Statement highlights:

  • The new American Heart Association Scientific Statement provides the latest advances in incorporating patient-reported symptoms and quality-of-life assessments into the routine care of people with peripheral arterial disease (PAD or blocked leg arteries). Provide a roadmap.
  • The patient-reported outcome measure (PROM) is a systematic study that asks individuals with PAD to rate their symptoms and share how their functioning (physical, social, emotional) and quality of life are affected. is a validated method.
  • PROM has been used as a key endpoint in clinical trials evaluating PAD treatment.
  • According to the new statement, PROM may also be used to assess the quality of programs that provide continuum care for patients with PAD.

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DALLAS, Oct. 13, 2022 — For approximately 8.5 million people in the United States with peripheral arterial disease (PAD – pronounced PAD), which narrows or blocks arteries in the legs, the criteria for treatment decisions and success are Should be guided by symptoms.Self-reported quality of life, according to a new scientific statement released today in the American Heart Association’s leading peer-reviewed journal circulationThe American Heart Association Scientific Statement is an expert analysis of current research and may inform future treatment guidelines.

The statement “Improving quality of care and outcomes in peripheral arterial disease through assessment of patient-reported health status” suggests that management of PAD based on patient symptom experience will lead to more patient-centered care and outcomes. I am emphasizing. Focus on care rather than relying on clinical measurements such as blood velocity to the leg or artery diameter.

“People with peripheral arterial disease are the authorities on how it impacts their daily lives. It has to go beyond physical measurements.” He is an associate professor of medicine and psychiatry and co-director of the Vascular Medical Outcomes Research (VAMOS) lab at Yale University in New Haven, Connecticut. “We have spent years developing and validating standardized tools to capture people’s experiences in a reliable and sensitive way. “We are now at a stage where we can begin to integrate this information into actual care through a pilot program that will allow us to develop quality benchmarks from their perspective for the type of care they receive.”

Foot pain and other patient experiences

Most people with peripheral arterial disease are over the age of 40, but PAD also occurs in younger people. People with PAD have blockages in the arteries that supply blood to their legs and feet, often causing pain, cramping, or weakness when walking, and needing to stop and rest temporarily until the pain subsides. Some people However, many patients may remain pain-free simply because they limit their activities. Studies have shown that their health and functioning are also affected. People who have severely restricted blood flow to their legs (called critical limb ischemia) may experience pain even with rest, have wounds that do not heal, or develop gangrene that can lead to amputation. there is. PAD is also a risk factor for heart attack and stroke.

“All of these conditions have a tremendous impact on people’s daily functioning and quality of life, and the more severe the disease, the greater the impact. Outcomes include type 2 diabetes, coronary artery disease, renal dysfunction, It is also affected by other health conditions commonly seen in PAD patients, such as mental health conditions such as depression and stress-related disorders,” Smolderen said.

patient-driven treatment

Coordination of care to risk factors and patient concerns is put at the forefront when health care teams are becoming more aware and aware of the burden of disease on quality of life. This statement advocates improving and individualizing care for people with clogged leg arteries by collecting feedback from their experiences during treatment.

The patient-reported outcome measure (PROM) is a systematic and validated method of directly asking patients how their illness affects their symptoms, functioning (physical, social, emotional) and quality of life. PROM feedback provides a more robust and objective assessment of the quality of care for PAD patients.

The main advantages of using PROM are:

  • Develop a real-life understanding of PAD in patients.
  • improve patient self-management of symptoms and medical needs;
  • Standardize quality performance benchmarks for caring for PAD patients.When
  • Provide relevant feedback to determine changes or need for treatment.

Involving patients in their experiences as professionals can direct attention to quality of life and cardiovascular risk factors and may help clinicians think beyond specific interventions. This perspective can lead to conversations that shift treatment or connect patients with other resources such as behavioral health services, wound care, and smoking cessation. Patient-centered care can also enhance self-management and share decision-making between patients and clinicians.

All of these benefits are possible, regardless of literacy level, language barriers, or cultural norms, as long as patient-reported outcome measures are assessed using tools that patients understand. It is also important that PROM is conducted by qualified and understanding professionals who administer the tools, interpret findings, and connect patients to additional resources. This statement includes examples of PROMs for measuring leg pain and function (including gait disturbance), PAD-specific health conditions, general health conditions, and depressive symptoms.

Performance measurement to improve quality of care

PROM can also be an integral part of evaluating whether a program is providing quality care to people with PAD. Backed by the Centers for Medicare and Medicaid Services and the National Quality Forum, PROM is increasingly integrated into the definition of what it means to provide patient-centred, quality clinical care, and PROM scores have a direct impact on reimbursement. may give. To evaluate the program, the PROM will be converted into a patient-reported outcome performance measure (PRO-PM).

With PRO-PM you have the following possibilities:

  • Provide measurable goals for programs to improve quality of care.
  • Encourage training and expertise development to help healthcare systems administer, interpret, and ethically use PRO-PM to improve patient care.
  • Reduce disparities in care and promote health equity.When
  • Help create national standards for quality care.

“This roadmap highlights a paradigm shift that puts the patient experience at the center, a departure from the status quo. It is provocative to engage people with PAD and put the lived experience of this disease at the forefront to provide information to hold the health system and health care workers accountable for whether or not they have been diagnosed with PAD. It’s a current, evidence-based treatment,” said Smolderen.

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association’s Council on Peripheral Vascular Disease and the Council on Lifestyle and Cardiometabolic Health. Writing groups include patient advocates and experts in clinical psychology, outcome research, nursing, cardiology, vascular surgery, and vascular medicine. It was important to ensure that this statement embodies the multidisciplinary nature of PAD care and our dedication to innovation in vascular space across vascular specialties. as well as experts with direct input from pioneers and patient advocates in the field of patient-reported outcomes for cardiovascular populations.

Scientific statements from the American Heart Association help raise awareness and facilitate informed health care decisions about cardiovascular disease and stroke issues. A scientific statement outlines what is currently known about the topic and areas where additional research is needed. Scientific statements inform the development of guidelines but do not make treatment recommendations. The American Heart Association guidelines provide the association’s official clinical practice recommendations.

Co-author is Chair Carole Decker, Ph.D., RN. Dr. Oramid Arabi, M.D. Tracy C. Collins, MD, MPH, MS. Bernard P. Dennis, BA. Philip P. Goodney, MD. Carlos Mena Hartado, MD. and John A. Spertus, MD, MPH Author disclosures are provided in the manuscript.

The association is primarily funded by individuals. Foundations and companies (including pharmaceuticals, device manufacturers, and other companies) also make donations to fund specific programs and events of the association. The Society has strict policies to prevent these relationships from affecting the content of science. Revenues from pharmaceutical companies, biotech companies, device manufacturers, health insurers, and the association’s overall financial information are available here.

Additional resources:

About the American Heart Association

The American Heart Association is a constant force for living longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Working with dozens of organizations and supported by millions of volunteers, we fund groundbreaking research, advocate for public health, and share life-saving resources. The Dallas-based organization has been a leading source of health information for nearly a century., Facebook, twitter Or call 1-800-AHA-USA1.


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