One-Year Health Status Outcomes Following Early Invasive and Noninvasive Treatment in Symptomatic Peripheral Artery Disease

Suveen Angraal, Vittal Hejjaji, Yuanyuan Tang, Kensey L. Gosch, Manesh R. Patel, Jan Heyligers, Christopher J. White, Rudolf Tutein Nolthenius, Carlos Mena-Hurtado, Herbert D. Aronow, Gregory L. Moneta, Robert Fitridge, Peter A. Soukas, J. Dawn Abbott, Eric A. Secemsky, John A. Spertus, Kim G. Smolderen

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    1 Scopus citations


    BACKGROUND: Lifestyle changes and medications are recommended as the first line of treatment for claudication, with revascularization considered for treatment-resistant symptoms, based on patients’ preferences. Real-world evidence comparing health status outcomes of early invasive with noninvasive management strategies is lacking. METHODS: In the international multicenter prospective observational PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry, disease-specific health status was assessed by the Peripheral Artery Questionnaire in patients with new-onset or worsening claudication at presentation and 3, 6, and 12 months later. One-year health status trajectories were compared by early revascularization versus noninvasive management on a propensity-matched sample using hierarchical generalized linear models for repeated measures adjusted for baseline health status. RESULTS: In a propensity-matched sample of 1000 patients (67.4±9.3 years, 62.8% male, and 82.4% White), 297 (29.7%) underwent early revascularization and 703 (70.3%) were managed noninvasively. Over 1 year of follow-up, patients who underwent early invasive management reported significantly higher health status than patients managed noninvasively (interaction term for time and treatment strategy; P<0.001 for all Peripheral Artery Questionnaire domains). The average 1-year change in Peripheral Artery Questionnaire summary scores was 30.8±25.2 in those undergoing early invasive, compared with 16.7±23.4 in those treated noninvasively (P<0.001). CONCLUSIONS: Patients with claudication undergoing early invasive treatment had greater health status improvements over the course of 1 year than those treated noninvasively. These data can be used to support shared decision-making with patients. REGISTRATION: URL:; Unique identifier: NCT01419080. GRAPHIC ABSTRACT: A graphic abstract is available for this article.

    Original languageEnglish (US)
    Pages (from-to)E011506
    JournalCirculation: Cardiovascular Interventions
    Issue number6
    StatePublished - Jun 1 2022


    • health status
    • life style
    • patient preferences
    • quality of life
    • registries

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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