Management, and Health Status Outcomes Of Obese Patients With Symptomatic Peripheral Artery Disease: Insight From The Portrait Registry
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Abstract
Obesity is present in 36.2%, 20.4 % and 29.0% of adults in the US, Netherlands and Australia respectively. Obesity is a risk factor for cardiovascular disease and related complications. The management and health status implications of obesity in patients with peripheral artery disease (PAD) is unknown. Participants from The Patient-centered Outcomes Related to Treatment practices in peripheral Arterial disease: Investigating Trajectories (PORTRAIT), an international registry of patients presenting with new or worsening PAD symptoms to a vascular clinic, were included in this analysis. Weight and height at baseline and 12-month follow up were abstracted from patients’ charts. BMIs (kg/m²) were categorized as normal (18.4 - 24.9), overweight (25 -29.9), and obese (≥ 30). PAD specific health status was assessed using the Peripheral Artery Disease Questionnaire Summary Score (PAQSS) at baseline and 12 months. Among obese participants, we abstracted information about referral to weight/diet counseling during the initial PAD visit and examined site variability in referral rates using hierarchical logistic regression to estimate median odds ratios (MOR). Multivariable linear regression, adjusting for demographics and comorbidities, was used to assess the relationship between obesity (vs. normal weight) and PAQ SS at baseline and 12 months. Linear regression models were replicated using BMI modeled as a continuous variable. Among 989 enrollees with documented BMI at baseline, the overall prevalence of obesity was 37%, but differed by country (41.4% USA, 19.5% Netherlands, 45.5% Australia, p =0.001). Only 21% of obese patient were referred to weight counseling. There was significant variability in referring overweight/obese participants for weight counselling across sites (range 0 – 41%, MOR = 3.3, 95% CI 2.0 – 7.3). Compared with normal weight, obesity was associated with worse PAQ summary score at baseline (mean difference= -7.2, 95% CI -10.4 to -4.1, p <0.01) and at 12 months (-7.4, 95% CI -11.4 to -3.5, p = 0.003), in unadjusted but not multivariable adjusted analysis accounting for demographics and smoking status (p > 0.05). In conclusion, the prevalence of obesity was higher among symptomatic PAD patients in the USA and Australia compared with the Netherlands and the general population of these countries. Referrals to weight counseling occurred only in 1 out of 5 obese patients. There was significant variability in weight counseling for obese/overweight participants, and obese patients consistently reported worse health status compared with normal weight patients. Obesity should be tested as a potential therapeutic target for comprehensive PAD management.
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Introduction -- Methodology -- Results -- Discussion -- Appendix
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M.S.