SS13 - Characterizing Patient-reported Claudication Treatment Goals to Support Patient-centered Treatment Selection and Outcomes Assessment Strategies

Objectives: Patient-reported outcomes (PRO) are increasingly emphasized for peripheral artery disease (PAD). Patient-defined treatment goals and expectations, however, are poorly understood and may not be achievable or aligned with guidelines or traditional measures of successful outcomes. We evaluated patient-reported activity goals related to PAD treatment in patients with claudication.

Methods: Patients reporting claudication with PAD confirmed by abnormal ABI and/or TBI were prospectively recruited. Patient-reported outcomes included characterizing minimum important walking improvement and specific activities associated with symptoms and treatment goals. Covariates included demographics, smoking status, Elixhauser comorbidity index, ABI, and TBI. Quality of life (QOL) was evaluated with the PADQOL instrument. Associations were evaluated with linear models and nonparametric tests.

Results: 133 patients meeting the inclusion criteria participated. Mean age was 69±11.4 years, and 35% were women. Mean ABI was 0.69 ±0.2, and mean TBI was 0.52. 67% of respondents indicated a distance ≥0.5 miles (2640 feet) and 64% indicated a duration ≥ 30 minutes as minimum important differences from PAD treatment (Figure 1). Common activities used to define symptoms and/or goals in free text responses included exercise (22%), labor tasks associated with activities of daily life (15%), uphill walking (11%), climbing stairs (8%), shopping (6%), and ability to walk on uneven terrain or surfaces (5%). Age was associated with higher PADQOL-based “social relationship” (P=0.04) and “fear and uncertainty” (P < 0.01) factor scores as well as the “job” questionnaire item (P < 0.01), indicating better QOL for older patients. No associations between PADQOL and comorbidity were observed.

Conclusions: Patients define treatment goals based on activities and expectations that may impact how they view outcomes. For many patients, minimum walking distance (≥0.5 miles) and duration (≥30 minutes) improvement expectations significantly exceed current walking measurement approaches and definitions of minimum important difference. Future work will explore ways to measure these goals objectively and consider whether they can be achieved with medical versus surgical intervention.