AHA Statement Notes Symptoms, Quality of Life Important to Guide Treatment for Peripheral Artery Disease

A new American Heart Association (AHA) scientific statement emphasized that for US patients with peripheral artery disease (PAD), which is narrowed or clogged arteries in the legs, treatment decisions and criteria for success should be determined by their symptoms and self-reported quality of life.

The statement, titled “Advancing peripheral artery disease quality of care and outcomes through patient-reported health status assessment,” describes how managing PAD based on a person’s experience of symptoms can lead to more patient-centered care and outcomes that focus on high-value care instead of relying on clinical measures, such as the speed of blood flow to the legs or artery diameter.

“The person living with peripheral artery disease is the authority on the impact it has on their daily life. Our treatment must be grounded in their lived experiences and go beyond the clinical measures of how well blood flows through the arteries,” said lead author of the statement writing group Kim G. Smolderen, PhD, a clinical psychologist and an associate professor of medicine and psychiatry and co-director of the Vascular Medicine Outcomes Research (VAMOS) lab at Yale University in New Haven, Connecticut, in a press release. “We have spent years developing and validating standardized instruments to capture people’s experiences in a reliable and sensitive way. We are now at a point where we can start integrating this information into real-world care, through pilot programs that can develop quality benchmarks for different phenotypes of patients with PAD and the types of treatments they undergo, as seen from their perspective.”

Although some patients with PAD do not experience any serious symptoms, others feel pain, cramping, or weakness when walking, which can limit their movement and activities. Previous studies have shown that PAD also impacts health status and functioning. People with severely limited blood flow to the legs may even experience pain while resting and may be unable to heal when they sustain a wound or develop gangrene, which could lead to amputation.

“All of these manifestations have a tremendous impact on people’s daily functioning and quality of life, with more impact as the severity of the disease increases. Outcomes are also affected by other health conditions common among people with PAD, such as type 2 diabetes, coronary artery disease, kidney dysfunction or mental health conditions like depression or stress-related disorders,” Smolderen said in the press release.

The AHA statement strongly advocates for improving and individualizing the care of people with clogged leg arteries by gathering feedback from their experience through treatment. Patient-reported outcomes measures (PROMs) are systemic, validated ways that allow individuals to assess how their disease impacts their symptoms; physical, social, and emotional well-being; and quality of life.

Some key benefits of using PROMs include:

• Improving patients comprehension of their lived experience with PAD.
• Improving self-management of symptoms and medical needs.
• Standardizing quality performance benchmarks for practices that care for patients with PAD.
• Providing relevant feedback to determine treatment changes or needs.

These benefits are apparent if the patient-reported outcomes measures are assessed using tools that the patient understands, regardless of literacy level, language barriers, and cultural norms, according to the researchers. Additionally, it is important that PROMs are conducted by experts who have the qualifications and understanding to administer the tools, interpret the findings, and connect patients with additional resources.

The statement also includes examples of PROMs to measure leg pain and functioning, PAD-specific health status, general health status, and depressive symptoms.

To evaluate certain programs, such as those that provide quality care for people with PAD, PROMs are translated into Patient-Reported Outcomes Performance Measures (PRO-PMs).

The use of PRO-PMs can:

1. Provide measurable goals for programs to enhance their quality of care.
2. Encourage the development of training and expertise for health systems to administer.
3. Interpret and ethically use PRO-PMs to improve patient care.
4. Reduce disparities in care and promote health equity.
5. Help create national standards for quality care.

“This roadmap highlights a paradigm shift that places the patient experience front and center, which is a departure from the status quo. It is provocative to now place the lived experience with the disease at the forefront, engaging people with PAD to provide information that holds health systems and practitioners accountable as to whether high-quality care was delivered, in addition to assessing the safe and effective delivery of current evidence-based treatments,” Smolderen said in the press release.

REFERENCE

Symptoms, quality of life important to guide treatment for peripheral artery disease (PAD). American Heart Association. October 13, 2022. Accessed October 14, 2022. https://newsroom.heart.org/news/symptoms-quality-of-life-important-to-guide-treatment-for-peripheral-artery-disease-pad?preview=948f