Cumulative Number of Treatment Interventions Predicts Health-Related Quality of Life in Patients with Critical Limb Ischemia
Cumulative Number of Treatment Interventions Predicts Health-Related Quality of Life in Patients with Critical Limb Ischemia
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DOI：
10.1016/j.avsg.2017.01.029
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发表时间：
2017-10-01
影响因子：
1.5
通讯作者：
Burke, Gregory L.
中科院分区：
文献类型：
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作者：
Corriere, Matthew A.;Goldman, Matthew P.;Burke, Gregory L.
背景：健康相关的生活质量（QOL）通常在单次干预后的规定时间间隔后进行评估，但严重肢体缺血（CLI）是一种慢性疾病，患者一生中通常需要多次干预。我们假设，在之前多次干预的情况下，CLI 治疗干预对生活质量的影响会减弱。为了检验这一假设，我们进行了一项横断面研究，评估既往外周动脉疾病 (PAD) 治疗干预的累积次数与针对合并症和疾病严重程度调整的生活质量之间的关系。方法：患有 CLI（异常踝臂指数 [ABI] 加上静息痛和/或组织损失）的参与者参加横断面研究并完成疾病特异性生活质量评估（血管生活质量问卷 6 [VascuQol-6]）。最小 ABI 用于评估疾病严重程度，并根据查尔森合并症指数评估合并症。 PAD 治疗干预的累积次数是根据双腿的终生总数来定义的。使用针对年龄和性别进行调整的多变量线性回归模型来评估 QOL 关联。结果：32 名 CLI 患者参与。平均年龄为 63 +/- 10 岁，72% 为男性，63% 为白人；平均 ABI 为 0.6 +/- 0.2。平均 VQ-6 评分为 11.6 +/- 4.2，先前接受过更多干预的患者的生活质量较低。多变量模型表明，越来越多的既往治疗干预措施对 QOL (P = 0.047) 产生负面影响，而对女性 (P = 0.006) 和 ABI (P = 0.006) 则呈正相关。未发现合并症与生活质量之间存在关联。结论：血管特异性因素似乎是 CLI 患者生活质量的关键决定因素，而合并症似乎不太重要。专注于明确且持久的血运重建的策略可能会减少累积干预措施，并有可能最大限度地提高 CLI 患者的生活质量。
Background: Health-related quality of life (QOL) is usually assessed after a defined interval following a single intervention, but critical limb ischemia (CLI) is a chronic condition where multiple interventions are often required over a patient's lifetime. We hypothesized that the impact of CLI treatment interventions on QOL is diminished in the setting of multiple previous interventions. To test this hypothesis, we performed a cross-sectional study evaluating associations between cumulative number of previous peripheral artery disease (PAD) treatment interventions and QOL adjusting for both comorbidity and disease severity.Methods: Participants with CLI (abnormal ankle brachial index [ABI] plus rest pain and/or tissue loss) were enrolled in a cross-sectional study and completed a disease-specific QOL assessment, (the Vascular Quality of Life Questionnaire-6 [VascuQol-6]). Minimum ABI was used to assess disease severity, and comorbidity was evaluated based on Charlson Comorbidity Index. Cumulative number of PAD treatment interventions was defined based on the lifelong total for both legs. QOL associations were evaluated using a multivariable linear regression model adjusted for age and gender.Results: Thirty-two patients with CLI participated. Mean age was 63 +/- 10 years, 72% were men, and 63% were white; mean ABI was 0.6 +/- 0.2. Mean VQ-6 score was 11.6 +/- 4.2, and QOL was lower in patients with more previous interventions. Multivariable models demonstrated that an increasing number of previous treatment interventions negatively impacted QOL (P = 0.047), whereas positive associations were identified for female gender (P = 0.006) and ABI (P = 0.006). No association between comorbidity and QOL was identified.Conclusions: Vascular-specific factors appear to be key determinants of QOL among patients with CLI, whereas comorbidity appears less important. Strategies focused on definitive and durable revascularization may reduce cumulative interventions and potentially maximize QOL for patients with CLI.