The prevalence of peripheral arterial disease (PAB) is high, particularly asymptomatic. Patients with an asymptomatic disease have increased a risk of cardiovascular mortality and cardiovascular events. Patients with PAD, particularly symptomatic patients, have worse quality of life. At the primary level, we have a simple method for the detection of PAD. Ankle-brachial index is a measure with high specificity and sensitivity. Many general questionnaires on quality of life were used for PAB. COOP/WONCA is one of the general functional status questionnaires, which have been used for many chronic diseases, but not for PAB.
The aim of this study was to assess the functional status of patients with PAB and to compare them with a group of patients who have normal ankle-brachial index. The second objective was to determine which factors affect functional status. The main aim of the study was a year follow-up regarding mortality, morbidity and functional status changes.
METHODS AND MATERIALS
This study is a part of a wider research project on PAB called PID-PAB. The study was a prospective observational and representative for Slovenia. The basic demographic data of patients, risk factors and information on cardiovascular diseases, ankle-brachial index, clinical status and laboratory results were collected. A questionnaire COOP/WONCA was completed by all participants. After a year, the data were collected again. Mortality, hard and soft events were observed.
85 physicians included 827 patients with PAB and 789 controls. The functional status of patients with PAB was in all aspects (physical fitness, emotions, everyday activities, social activities and general health) and in the sum score significantly worse than in the control group. The most important factors, having an impact on functional status, were: sleep problems, moderate exercise, the number of medicines, ankle-brachial index, irritability, intense exercise and haemoglobin.
The functional status of more than a half of patients did not change within one-year observation. For the full sample only physical fitness, daily activities and sum score deteriorated, but only in physical fitness statistically significant. In all other aspects of the functional status more patients improved than deteriorated.
The initial overall assessment of COOP/WONCA did not predict mortality within one-year observation. It predicted the hard events, particularly myocardial infarction and revascularisations, mostly in coronary and peripheral arteries.
The group of patients with PAB compared to the control group had more revascularisations, particularly in coronary and peripheral arteries. There was no statistical difference between groups regarding death and hard events.
There are significant differences in the functional status among the groups. In a year functional status did not change significantly. Also, there is no difference in mortality in hard events within one-year observation. Therefore, more years of observation are needed. |