Patient-Defined Goals Support Tailored Approaches to Claudication Treatment Selection

Patients with peripheral artery disease (PAD) and claudication define their symptoms and treatment goals via improvements in walking distance, duration, or speed, as well as in a variety of activities, investigators reported in the Journal of Vascular Surgery.

The cross-sectional survey study evaluated associations among clinically relevant patient characteristics, treatment goals, and patient-reported outcome (PRO) scores used for PAD.

Eligible participants had a clinical diagnosis of PAD with claudication symptoms and an abnormal ankle brachial index (ABI; ≤0.9) or noncompressible lower extremity arteries with an abnormal toe brachial index (≤0.7).

The patients completed an electronic survey that included items related to symptoms and treatment goals and 2 PAD-specific PROs, which were the PAD Quality of Life (PADQOL) and Walking Impairment Questionnaire (WIQ) tools.

A total of 150 patients were included (mean age, 70.0±11.3 years; 32.9% women; 94.4% White). Their self-categorized primary treatment goals were increased walking speed (8.0%), ability to perform a specific activity or task (23.0%), increased walking distance or duration without stopping (62.0%), or other/none of these (7.0%).

Among the participants who reported that increased walking distance and duration was their primary goal, 64.0% chose a minimum distance of 0.5 miles or longer and 59.0% indicated a minimum duration of 30 minutes or longer without stopping as cutoff points for meaningful improvement.

Increasing age was associated with lower odds of a walking distance improvement goal of 0.5 miles or longer (univariable odds ratio [OR], 0.68; 95% CI, 0.51-0.92; P =.012 per 5-year increase). In addition, increasing age was associated with decreased odds of a walking duration improvement goal of 30 minutes or longer (OR, 0.76; 95% CI, 0.58-0.99; P =.047 per 5-year increase).

The most common activity-specific treatment goals were sports (24%), outdoor recreation (19.3%), chores (17.3%), climbing stairs (11.3%), uphill or incline walking (11.3%), and shopping (6.0%).

Among characteristics associated with PADQOL single-item percentile scores, age was associated with social relationships and interactions (estimate 3.28±1.38; P =.020), fear and uncertainty (estimate 4.81±1.29; P <.001), and job function (OR, 1.45; 95% confidence limit, 1.20-1.78; P <.001). ABI was associated with social relationships and interactions (estimate 27.99±11.7; P =.018), symptoms and physical function limitations (estimate 34.6±13.4; P =.012), fear and uncertainty (estimate 32.7±10.8; P =.003), and positive adaptation (estimate 23.8±9.18; P =.011).

Significant associations with ABI were found regarding WIQ distance (estimate 51.9±14.5; P <.001) and speed (univariable estimate 34.1±13.9; P =.017) subscale percentile scores.

Moderate correlations were observed between PADQOL factor and WIQ percentile scores. The PADQOL factor of symptoms and limitations in physical functioning was most closely correlated with WIQ subscale percentile scores.

The researchers noted that limited racial diversity prevents exploration of race-based hypotheses. Also, the cross-sectional design does not assess changes in PRO scores or achievement of the activity-based goals identified. In addition, the clinic-based recruitment approach does not include or exclude participants based on previous or planned vascular interventions, and the analysis is limited to patients with claudication.

“Patients with claudication define symptoms and treatment goals from a variety of perspectives, some of which are measured with available PRO while others are not,” the investigators wrote. “This heterogeneity supports consideration of tailored treatment strategies and PRO selection informed by patient characteristics and goals.”