AHA statement: PAD treatment must focus on patient-reported symptoms, quality of life
Patient-reported outcome measures that assess a range of relevant domains such as health status and quality of life are vital for the comprehensive management of peripheral artery disease, according to a new scientific statement.
Despite guidelines to outline best practices for care of patients with PAD, there is great variability in practice and new methods are needed to quantify the quality of health care to increase accountability for health care professionals to develop holistic strategies for improving the treatment of patients with PAD, Kim G. Smolderen, PhD, clinical psychologist, associate professor of medicine and psychiatry and co-director of the Vascular Medicine Outcomes (VAMOS) research program at Yale University, and colleagues wrote in Circulation.
“The person living with peripheral artery disease is the authority on the impact it has on their daily life,” Smolderen, also vice chair of the statement writing group, said in a press release. “Our treatment must be grounded in their lived experiences and go beyond the clinical measures of how well blood flows through the arteries. We have spent years developing and validating standardized instruments to capture people’s experiences in a reliable and sensitive way. We are now at a point where we can start integrating this information into real-world care, through pilot programs that can develop quality benchmarks for different phenotypes of patients with PAD and the types of treatments they undergo, as seen from their perspective.”
Including the patient perspective
PAD can present with a spectrum of leg symptoms ranging from asymptomatic disease to exertional leg discomfort to critical limb ischemia, the researchers noted, adding that the negative impact of a PAD diagnosis on daily life “cannot be overstated.”
“Assessing outcomes in patients with PAD is important to drive health care delivery and to optimize disease management,” the researchers wrote. “Outcome measures that include the perspectives of patients can guide not only patients and their families as they make decisions about their health and treatment but also health care professionals and health systems, as well as health policymakers, as to what constitutes quality of PAD care.”
The scientific statement calls for validated patient-reported outcome measures that can be integrated into clinical practice to measure the impact and quality of PAD care.
By integrating patient-reported outcome measures, programs can enhance their quality of care, reduce disparities in care and promote health equity and aid in the creation of national standards for quality care, according to the researchers.
“[B]ecause PAD care is not delivered by a single specialty, national data registry initiatives collecting patient-reported outcome performance measures will need to be instituted with stewards from professional and quality organizations that can ensure quality and advocacy reflecting this diversity,” the researchers wrote. “A special effort needs to be made to represent diverse patient populations, including hard-to-reach populations, regardless of the management strategy that patients are undergoing, and to ensure representation of different PAD care specialties and allied health professionals who take care of patients with PAD.”
Go beyond ‘treating the lesion’
The researchers noted that PAD is commonly underdetected and undertreated; many multidisciplinary team approaches focus on treating the disease, not the patient with the disease.
“Meeting the care needs of patients with PAD goes beyond treating the lesion but benefits from a more holistic approach incorporating the broader range of functioning and quality of life affected by PAD,” the researchers wrote. “Integrating patient-reported outcome performance measures would mean an important paradigm shift in the way that quality PAD care is defined, starting from the patient’s perspective and not defined by the discipline treating it or by the latest technological advance.”
The researchers highlighted five main challenges going forward in PAD management: developing structural efforts to explore domains important to patients; compiling existing evidence and unifying data; better understanding differences in patient populations; stakeholder engagement and pilot testing measures; and developing patient-reported outcome measures that address evidence-based components of PAD care.
“This roadmap highlights a paradigm shift that places the patient experience front and center, which is a departure from the status quo,” Smolderen said in the release. “It is provocative to now place the lived experience with the disease at the forefront, engaging people with PAD to provide information that holds health systems and practitioners accountable as to whether high-quality care was delivered, in addition to assessing the safe and effective delivery of current evidence-based treatments.”
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