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

• Rha SW
• Choi SH
• Kim DI
• Jeon DW
• Lee JH
• Hong KS
• Cha TJ
• Cho JH
• Lee SK
• Park YH
• Park WJ
• Kim HJ
• Kim YJ
• Lee J
• Choi D
• the PADO research investigators

• KMID: 2418806
• DOI: http://doi.org/10.4070/kcj.2017.0340

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.

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