title: Declining walking impairment questionnaire scores are associated with subsequent increased mortality in peripheral artery disease.
abstract: OBJECTIVE
  This study determined whether greater 2-year declines in Walking Impairment Questionnaire (WIQ) stair climbing, distance, or speed scores were associated with higher all-cause and cardiovascular disease (CVD) mortality among men and women with lower extremity peripheral artery disease (PAD).
  
  
  BACKGROUND
  Associations of decline in the WIQ with mortality among people with PAD are unknown.
  
  
  METHODS
  Participants were 442 men and women with PAD identified from Chicago area medical centers. The WIQ was completed at baseline and at 2-year follow-up. Cox proportional hazard models were used to assess associations across categories of 2-year changes in WIQ stair climbing, WIQ distance, and WIQ speed scores with subsequent all-cause and CVD mortality, adjusting for age, sex, race, ankle-brachial index, body mass index, smoking, comorbidities, and other covariates.
  
  
  RESULTS
  One hundred twenty-three participants (27.8%) died during a median follow-up of 4.7 years after the 2-year change in WIQ score measurements. Forty-five participants died from CVD. Adjusting for covariates, participants with WIQ score declines ≥20.0 points had higher all-cause mortality (hazard ratio [HR]: 1.93, 95% confidence interval [CI]: 1.01 to 3.68 for WIQ stair climbing; HR: 2.34, 95% CI: 1.15 to 4.75 for WIQ distance; and HR: 3.55, 95% CI: 1.57 to 8.04 for WIQ speed, respectively) compared with participants with ≥20.0 point improvement in each of the corresponding WIQ categories. Participants with ≥20.0 point declines in the WIQ distance score had higher CVD mortality (HR: 4.56, 95% CI: 1.30 to 16.01) compared with those with ≥20.0 point improvement in the WIQ distance score.
  
  
  CONCLUSIONS
  Patients with PAD who experienced ≥20.0 point declines in the WIQ stair climbing, distance, and speed scores had a higher rate of all-cause mortality compared with those with less declines in each WIQ score.
authors.affiliation: Department of Medicine, The University of Chicago, Chicago, Illinois, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Jain
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: Huimin
authors.initials: H
authors.lastname: Tao
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D002641:Chicago / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D016138:Walking