title: Association between health status and long-term mortality after percutaneous revascularization of peripheral artery disease.
abstract: OBJECTIVE
  To explore the association of health status change and long-term survival among patients with symptomatic peripheral artery disease (PAD).
  
  
  BACKGROUND
  Early gains in health status after successful endovascular therapy (EVT) for symptomatic PAD can be maintained up to 1 year. Whether such health status improvements are associated with long-term survival benefits is unknown.
  
  
  METHODS
  Between February 2001 and August 2004, 258 patients with symptomatic PAD treated with EVT participated in a prospective study evaluating baseline and 1 year health status using the Peripheral Artery Questionnaire (range 0-100, higher scores = better). All-cause mortality was assessed for all patients at a median of 9.4 years following EVT.
  
  
  RESULTS
  The mean age at enrollment was 68 ± 11 years; 61% were male, 97% were Caucasian, and 38% had diabetes. Patients with a clinically meaningful health status improvement (≥8 points) 1 year after their index procedure (79%) were identified as responders. Responders had a significantly better 10 year survival compared with nonresponders (60% vs 38%, p = 0.025). Responder status was associated with a survival advantage that persisted in risk-adjusted analysis (adjusted hazard ratio for long-term mortality, 0.66 [95% CI, 0.45-0.97]; p = 0.036).
  
  
  CONCLUSIONS
  Among patients with symptomatic PAD undergoing EVT, improvement of PAD-specific health status at 1 year follow-up was associated with improved long-term survival. Whether additional treatment for patients with poor response to EVT could improve long-term survival warrants further investigation. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Bunte
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: University of Texas-Southwestern Medical Center, Dallas, Texas.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.|University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: David M
authors.initials: DM
authors.lastname: Safley
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: angioplasty; peripheral artery disease; quality of life