Depressive symptoms may worsen health status in PAD
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Women with peripheral artery disease were more likely to have depressive symptoms compared with men, researchers found.
The study, published in the Journal of the American Heart Association, also found that patients with PAD and depressive symptoms had worse health status throughout the year after their PAD diagnosis compared with those without depressive symptoms.
“If depressive symptoms are the most predictive factors associated with patients’ PAD health status outcomes following PAD specialty treatment (medications, invasive treatment and exercise therapy) and is predictive of an adverse prognosis (mortality and cardiovascular events) in the real world, something needs to be done,” Kim Smolderen, PhD, FAHA, clinical health psychologist and co-director of the Vascular Medicine Outcomes (VAMOS) program at Yale Medicine, told Healio. “We need to move to a more holistic way of treating this disease.”
Data from the PORTRAIT registry
In this international, prospective, observational study, Qurat-Ul-Ain Jelani, MD, interventional cardiologist in training at Yale University School of Medicine, and colleagues analyzed data from 1,243 patients (mean age, 68 years; 38% women) from the PORTRAIT registry with new or worsening PAD. The eight-item Patient Health Questionnaire was used to assess depressive symptoms at baseline and 3 months. Health status was measured at baseline, 3, 6 and 12 months using the Peripheral Artery Questionnaire and the generic EQ-5D visual analogue scale.
“Depression and depressive symptoms are prevalent among patients with PAD,” Smolderen said in an interview. “Making lifestyle changes while dealing with chronic mood issues is extremely difficult. We do not screen for mood disorders in this population, and yet we ask patients to change their entire lifestyle and expect them to be successful.”
Moderate to severe depressive symptoms on presentation were observed in 16% of patients. Rates of depressive symptoms were higher in women compared with men (21.1% vs. 12.9%; P < .001).
Patients with depressive symptoms at PAD presentation had lower Peripheral Artery Questionnaire health status scores at each time point vs. baseline (adjusted mean score, 25.4 vs. 46.7; P < .0001). This was also observed at 12 months of follow-up (adjusted mean score, 50 vs. 66.1; P < .0001). Differences between groups ranged from 16.3 to 21.4.
There also was an interaction between depressive symptoms and time (P < .0001). Similar results were observed for EQ-5D visual analogue scale scores. The magnitude of change in health status scores at 1 year did not differ by sex.
Symptoms of depression explained 19% of the link between sex differences for Peripheral Artery Questionnaire summary scores at 1 year.
“PAD is a chronic disease affecting broad domains of functioning, and to be able to manage it successfully, patients also need adequate recognition and treatment support for their increased mental health burden,” Smolderen told Healio. “Integrating care pathways that screen for and address mental health concerns could open up opportunities to maximize PAD treatment results. PAD treatment is more than treating the blockages in patients’ legs.”
Additional research on screening
More research is needed to determine whether screening for mental health concerns improves outcomes in these patients, according to Smolderen.
“Whether screening for depression or other mental health concerns in PAD is beneficial to improve outcomes remains to be studied,” she said. “Screening advisories for depression in general populations and for anxiety specifically in women are existing through the U.S. Preventive Services Task Force and may provide useful information as to what support systems for screening and treatment are advised to be in place in the care setting.”
Despite this need for additional research for screening, Smolderen emphasized the importance of patients speaking with their providers if they are experiencing depressive symptoms.
“Patients with PAD who feel overwhelmed or experience depressive symptoms should not feel that they are alone with this and that the problem is not to be ignored,” she said. “Depressive symptoms may prevent you from realizing optimal benefit from your PAD treatment. Bringing concerns about your mood up to your provider is an important step. There is evidence-based care available to treat depression. At the same time, a greater awareness by PAD specialists for this problem is important so that patients can be connected with the right care resources and support.”
For more information:
Kim Smolderen, PhD, FAHA, can be reached at kim.smolderen@yale.edu; Twitter: @kimgsmolderen.
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