Korean Circ J.  2018 Sep;48(9):813-825. 10.4070/kcj.2017.0340.

Medical Resource Consumption and Quality of Life in Peripheral Arterial Disease in Korea: PAD Outcomes (PADO) Research

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
  • 2Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea.
  • 3Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 5Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
  • 6Division of Cardiology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
  • 7Division of Cardiology, Department of Internal Medicine, Kosin University, Gospel Hospital, Busan, Korea.
  • 8Division of Cardiology, Department of Internal Medicine, St. Carollo Hospital, Suncheon, Korea.
  • 9Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 10Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 11Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 12Outcomes Research and Real World Data, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea.
  • 13Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
  • 14Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. CDHLYJ@yuhs.ac

Abstract

BACKGROUND AND OBJECTIVES
We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea.
METHODS
This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis.
RESULTS
This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p < 0.001) compared to deterioration/maintain stage II-IV.
CONCLUSIONS
Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.

Keyword

Peripheral arterial disease; Disease burden; Quality of life

MeSH Terms

Adult
Angiography
Ankle Brachial Index
Arteries
Aspirin
Comorbidity
Constriction, Pathologic
Diagnosis
Drug Therapy
Extremities
Humans
Hyperlipidemias
Hypertension
Ischemia
Korea*
Linear Models
Male
Orthopedics
Peripheral Arterial Disease*
Prospective Studies
Quality of Life*
Smoking Cessation
Ultrasonography
Aspirin

Figure

  • Figure 1 (A) Average number of institutions visited, mean (min, max): 1.52/patient (1, 7). (B) Average number of type of symptoms experienced, mean (min, max): 1.47/patient (1, 5). (C) Average number of diagnosis, mean (min, max): 1.14/patient (1, 3). (D) Average number of interventions/tests, mean (min, max): 2.88/patient (1, 8). (E) Average number of CAMs used, mean (min, max): 1.90/patient (1, 8).Data are presented as number and percentage (%).CAM = complementary and alternative medicine; CT = computerized tomography; MRI = magnetic resonance imaging; PAD = peripheral-arterial disease.

  • Figure 2 (A) Left: baseline, 0.64±0.24; Right: follow-up, 0.68±0.20; ΔQoL=0.04±0.20, *p<0.001 by t-test. (B) Left: baseline, 67.49±18.29; Right: follow-up, 71.56±16.33; ΔQoL=3.67±17.16; SD = standard deviation; QoL = quality of life.*p<0.001 by t-test.


Cited by  2 articles

Elucidation of the Diagnosis and Treatment of Peripheral Arterial Disease
Hyung Oh Kim, Weon Kim
Korean Circ J. 2018;48(9):826-827.    doi: 10.4070/kcj.2018.0155.

Endovascular Therapy of Iliac Artery Disease: Stent Matters
Su Hong Kim
Korean Circ J. 2021;51(5):452-454.    doi: 10.4070/kcj.2021.0022.


Reference

1. Choi SH. Current management of peripheral arterial disease. J Korean Med Assoc. 2010; 53:228–235.
2. Verma A, Prasad A, Elkadi GH, Chi YW. Peripheral arterial disease: evaluation, risk factor modification, and medical management. J Clin Outcomes Manag. 2011; 18:74–84.
3. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation. 2004; 110:738–743. PMID: 15262830.
4. Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA. 2006; 295:547–553. PMID: 16449620.
5. Rhee SY, Kim YS. Peripheral arterial disease in patients with type 2 diabetes mellitus. Diabetes Metab J. 2015; 39:283–290. PMID: 26301189.
6. Ko YG, Ahn CM, Min PK, et al. Baseline characteristics of the retrospective patient cohort in the Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases (K-VIS ELLA) Registry. Korean Circ J. 2017; 47:469–476. PMID: 28765738.
7. Creager MA. Results of the CAPRIE trial: efficacy and safety of clopidogrel. Vasc Med. 1998; 3:257–260. PMID: 9892520.
8. Becker GJ, McClenny TE, Kovacs ME, Raabe RD, Katzen BT. The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol. 2002; 13:7–11. PMID: 11788688.
9. Novo S. Classification, epidemiology, risk factors, and natural history of peripheral arterial disease. Diabetes Obes Metab. 2002; 4(Suppl 2):S1–S6.
10. Izquierdo-Porrera AM, Gardner AW, Bradham DD, et al. Relationship between objective measures of peripheral arterial disease severity to self-reported quality of life in older adults with intermittent claudication. J Vasc Surg. 2005; 41:625–630. PMID: 15874926.
11. Issa SM, Hoeks SE. Health-related quality of life predicts long-term survival in patients with peripheral artery disease. Vasc Med. 2010; 15:163–169. PMID: 20483986.
12. Hirsch AT, Hartman L, Town RJ, Virnig BA. National health care costs of peripheral arterial disease in the Medicare population. Vasc Med. 2008; 13:209–215. PMID: 18687757.
13. Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017; 14:156–170. PMID: 27853158.
14. Kang EJ, Shin HS, Park HJ, Jo MW, Kim NY. A valuation of health status using EQ-5D. Korean J Health Econ Policy. 2006; 12:19–43.
15. Becker F, Robert-Ebadi H, Ricco JB, et al. Chapter I: definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011; 42(Suppl 2):S4–S12.
16. Liles DR, Kallen MA, Petersen LA, Bush RL. Quality of life and peripheral arterial disease. J Surg Res. 2006; 136:294–301. PMID: 17046794.
17. Wieland LS, Manheimer E, Berman BM. Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med. 2011; 17:50–59.
18. Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. Hyattsville: National Center for Health;2009.
19. Pittler MH, Ernst E. Complementary therapies for peripheral arterial disease: systematic review. Atherosclerosis. 2005; 181:1–7. PMID: 15939048.
20. Lu JT, Creager MA. The relationship of cigarette smoking to peripheral arterial disease. Rev Cardiovasc Med. 2004; 5:189–193. PMID: 15580157.
21. Meijer WT, Grobbee DE, Hunink MG, Hofman A, Hoes AW. Determinants of peripheral arterial disease in the elderly: the Rotterdam study. Arch Intern Med. 2000; 160:2934–2938. PMID: 11041900.
22. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2017; 135:e726–e779. PMID: 27840333.
23. Lee YH, Shin MH, Kweon SS, et al. Cumulative smoking exposure, duration of smoking cessation, and peripheral arterial disease in middle-aged and older Korean men. BMC Public Health. 2011; 11:94. PMID: 21310081.
24. Coleman T, Agboola S, Leonardi-Bee J, Taylor M, McEwen A, McNeill A. Relapse prevention in UK Stop Smoking Services: current practice, systematic reviews of effectiveness and cost-effectiveness analysis. [iii-iv.]. Health Technol Assess. 2010; 14:1–152.
25. Klonizakis M, Crank H, Gumber A, Brose LS. Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) - a study protocol. BMC Public Health. 2017; 17:293. PMID: 28376818.
26. Kang EJ, Ko SK. A catalogue of EQ-5D utility weights for chronic diseases among noninstitutionalized community residents in Korea. Value Health. 2009; 12(Suppl 3):S114–S117. PMID: 20586972.
27. Ferreiro JL, Bhatt DL, Ueno M, Bauer D, Angiolillo DJ. Impact of smoking on long-term outcomes in patients with atherosclerotic vascular disease treated with aspirin or clopidogrel: insights from the CAPRIE trial (Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events). J Am Coll Cardiol. 2014; 63:769–777. PMID: 24239662.
28. Suzuki J, Shimamura M, Suda H, et al. Current therapies and investigational drugs for peripheral arterial disease. Hypertens Res. 2016; 39:183–191. PMID: 26631852.
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr