High ankle brachial index predicts high risk of cardiovascular events amongst people with peripheral artery disease

Ankle-brachial pressure index (ABPI) is commonly measured in people referred to vascular specialists. This study aimed to assess the association of high ABPI (≥ 1.4) with cardiovascular events in people with peripheral artery disease (PAD). 1533 participants with PAD diagnosed by a vascular specialist were prospectively recruited from four out-patient clinics in Australia. ABPI was measured at recruitment and the occurrence of myocardial infarction (MI), stroke or cardiovascular death (major cardiovascular events; MACE) and any amputation were recorded over a median (inter-quartile range) follow-up of 3.3 (1.0-7.1) years. The association of high, compared to normal, low (0.5-0.9) or very low (<0.5), ABPI with clinical events was estimated using Cox proportional hazard analyses, adjusting for traditional risk factors and reported as hazard ratio with 95% confidence intervals. 596 (38.9%), 676 (44.1%), 157 (10.2%) and 104 (6.8%) participants had normal, low, very low and high ABPI, respectively. Participants with high ABPI had increased risk of MACE, MI and death by comparison to those with either normal ABPI [1.69 (1.07, 2.65), 1.93 (1.07, 3.46) and 1.67 (1.09, 2.56)] or either low or very low ABPI [1.51 (1.02, 2.23), 1.92 (1.16, 3.19) and 1.47 (1.02, 2.14)] after adjusting for other risk factors. Findings were similar in a sensitivity analysis excluding people with ABPI only measured in one leg (n = 120). Participants with high ABPI also had an increased risk of MACE and MI compared to those with very low ABPI alone. High ABPI is a strong indicator of excess risk of cardiovascular events amongst people with PAD

The reproducibility of measuring maximum abdominal aortic aneurysm diameter from ultrasound images

Background: Accurate repeat assessment of the diameter of an abdominal aortic aneurysm (AAA) is important. This study investigated the reproducibility of different methods of measuring AAA diameter from ultrasound images. Methods: Fifty AAA patients were assessed by ultrasound. Maximum AAA diameter was measured independently by three trained observers on two separate occasions using a standardised protocol. Five diameters were measured from each scan, three in the anterior-posterior (AP) and two in the transverse (TV) plane, including inner-to-inner (ITI), outer-to-outer (OTO) and leading edge-to-leading edge (LETLE). Intra- and inter-observer reproducibility were reported as reproducibility coefficients. Statistical comparison of methods was performed using linear mixed effects models. Results: Intra-observer reproducibility coefficients (AP LETLE 2.2 mm; AP ITI 2.4 mm; AP OTO 2.6 mm) were smaller than inter-observer reproducibility coefficients (AP LETLE 4.6 mm: AP ITI 4.5; and AP OTO 4.8 mm). There was no statistically significant difference in intra-observer reproducibility of three types of measurements performed in the AP plane. Measurements obtained in the TV plane had statistically significant worse intra-observer reproducibility than those performed in the AP plane. Conclusions: This study suggests that the comparison of maximum AAA diameter between repeat images is most reproducibly performed by a single trained observer measuring diameters in the AP plane

Health-related quality of life amongst people diagnosed with abdominal aortic aneurysm and peripheral artery disease and the effect of fenofibrate

The aims of this study were, firstly, to assess the effect of concurrent peripheral artery disease (PAD) on the health-related quality of life (QOL) of people diagnosed with a small abdominal aortic aneurysm (AAA); and secondly, to test whether the peroxisome proliferator-activated receptor alpha agonist fenofibrate improved QOL of people diagnosed with a small AAA, including those diagnosed with concurrent PAD. The study included both a cross-sectional observational study and a randomized placebo-controlled clinical trial. 140 people diagnosed with a 35-49 mm diameter AAA, 56 (40%) of whom had concurrent PAD, and 25 healthy controls were prospectively recruited. QOL was assessed with the short form (SF) 36. Findings in participants that were diagnosed with both AAA and PAD were compared separately with those of participants that had a diagnosis of AAA alone or who had neither AAA nor PAD diagnosed (healthy controls). All participants diagnosed with an AAA were then randomly allocated to 145 mg of fenofibrate per day or identical placebo. Outcomes were assessed by changes in the domains of the SF-36 and ankle brachial pressure Index (ABPI) from randomization to 24 weeks. Data were analyzed using Mann-Whitney U tests. Participants diagnosed with both AAA and PAD had significantly worse QOL than participants diagnosed with AAA alone or healthy controls. Fenofibrate did not significantly alter SF-36 scores or ABPI over 24 weeks. Fenofibrate does not improve QOL of people diagnosed with small AAA, irrespective of whether they have concurrent PAD.Trial registration: ACTN12613001039774 Australian New Zealand Clinical Trials Registry

Fenofibrate in the management of AbdoMinal aortic anEurysm (FAME): Study protocol for a randomised controlled trial

Background: Abdominal aortic aneurysm (AAA) is a slowly progressive destructive process of the main abdominal artery. Experimental studies indicate that fibrates exert beneficial effects on AAAs by mechanisms involving both serum lipid modification and favourable changes to the AAA wall. Methods/design: Fenofibrate in the management of AbdoMinal aortic anEurysm (FAME) is a multicentre, randomised, double-blind, placebo-controlled clinical trial to assess the effect of orally administered therapy with fenofibrate on key pathological markers of AAA in patients undergoing open AAA repair. A total of 42 participants scheduled for an elective open AAA repair will be randomly assigned to either 145 mg of fenofibrate per day or identical placebo for a minimum period of 2 weeks prior to surgery. Primary outcome measures will be macrophage number and osteopontin (OPN) concentration within the AAA wall as well as serum concentrations of OPN. Secondary outcome measures will include levels of matrix metalloproteinases and proinflammatory cytokines within the AAA wall, periaortic fat and intramural thrombus and circulating concentrations of AAA biomarkers. Discussion: At present, there is no recognised medical therapy to limit AAA progression. The FAME trial aims to assess the ability of fenofibrate to alter tissue markers of AAA pathology. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12612001226897. Registered on 20 November 2012. © 2017 The Author(s)

Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial

Background: Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD. Methods: This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation.Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research. Discussion: This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden. Trial registration: ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014

Using peer educator delivered seminars to improve the level of physical activity among older adults: a pilot investigation

Objectives: This research aimed to investigate the influence of peer educator delivered seminars to older adults on physical activity and exercise uptake, and whether improvements in activity levels and functional wellbeing follow. Design: Two part evaluation. Data are from a post-seminar survey that informed a process evaluation (Part 1 - Seminar) and a non-controlled prospective investigation (Part 2 - Cohort). Setting: Cohort data were collected from a regional community organisation and Seminar data at a number of meeting places for older adult organisations throughout Queensland. Participants: Seminar - 412 older adults, classified "Mostly third age" (> 65 years with average health), attended 23 seminars throughout the state. Cohort data were collected from nine adults (age 74.22 ± 4.43 years) at baseline and at two follow ups. Main outcome measures: Seminar satisfaction and intention to change data were collected by questionnaire post-seminars. Cohort data were collected for function, balance and quality of life pre-seminar, and four (PS1) and eight (PS2) weeks post. Results: Seminar data showed a raised awareness of the need for more movement, and an indication that individuals aimed to become more involved. For cohort, minutes per day sitting was significantly reduced at PS1 (p = 0.046) but not PS2, and a positive trend emerged for function and total METs-minutes per week. Conclusion: While further research is required, data suggest peer educator delivered seminars can have a positive impact on the intention to be active, and the activity levels and functional wellbeing of older adults. Peer educator delivered seminars may be a valuable complement to behaviour modification and social-ecological models in the drive towards seeing more adults become physically active

Using peer educator delivered seminars to improve the level of physical activity among older adults: A pilot investigation

Objectives: This research aimed to investigate the influence of peer educator delivered seminars to older adults on physical activity and exercise uptake, and whether improvements in activity levels and functional wellbeing follow. Design: Two part evaluation. Data are from a post-seminar survey that informed a process evaluation (Part 1 - Seminar) and a non-controlled prospective investigation (Part 2 - Cohort). Setting: Cohort data were collected from a regional community organisation and Seminar data at a number of meeting places for older adult organisations throughout Queensland. Participants: Seminar - 412 older adults, classified "Mostly third age" (> 65 years with average health), attended 23 seminars throughout the state. Cohort data were collected from nine adults (age 74.22 ± 4.43 years) at baseline and at two follow ups. Main outcome measures: Seminar satisfaction and intention to change data were collected by questionnaire post-seminars. Cohort data were collected for function, balance and quality of life pre-seminar, and four (PS1) and eight (PS2) weeks post. Results: Seminar data showed a raised awareness of the need for more movement, and an indication that individuals aimed to become more involved. For cohort, minutes per day sitting was significantly reduced at PS1 (p = 0.046) but not PS2, and a positive trend emerged for function and total METs-minutes per week. Conclusion: While further research is required, data suggest peer educator delivered seminars can have a positive impact on the intention to be active, and the activity levels and functional wellbeing of older adults. Peer educator delivered seminars may be a valuable complement to behaviour modification and social-ecological models in the drive towards seeing more adults become physically active

Using peer educator delivered seminars to improve the level of physical activity among older adults: a pilot investigation

Objectives: This research aimed to investigate the influence of peer educator delivered seminars to older adults on physical activity and exercise uptake, and whether improvements in activity levels and functional wellbeing follow. Design: Two part evaluation. Data are from a post-seminar survey that informed a process evaluation (Part 1 - Seminar) and a non-controlled prospective investigation (Part 2 - Cohort). Setting: Cohort data were collected from a regional community organisation and Seminar data at a number of meeting places for older adult organisations throughout Queensland. Participants: Seminar - 412 older adults, classified "Mostly third age" (> 65 years with average health), attended 23 seminars throughout the state. Cohort data were collected from nine adults (age 74.22 ± 4.43 years) at baseline and at two follow ups. Main outcome measures: Seminar satisfaction and intention to change data were collected by questionnaire post-seminars. Cohort data were collected for function, balance and quality of life pre-seminar, and four (PS1) and eight (PS2) weeks post. Results: Seminar data showed a raised awareness of the need for more movement, and an indication that individuals aimed to become more involved. For cohort, minutes per day sitting was significantly reduced at PS1 (p = 0.046) but not PS2, and a positive trend emerged for function and total METs-minutes per week. Conclusion: While further research is required, data suggest peer educator delivered seminars can have a positive impact on the intention to be active, and the activity levels and functional wellbeing of older adults. Peer educator delivered seminars may be a valuable complement to behaviour modification and social-ecological models in the drive towards seeing more adults become physically active

A Survey of the opinions of patients and health professionals about exercise therapy for peripheral artery disease

[Extract] Guidelines recommend exercise therapy for peripheral artery disease (PAD) but uptake is poor, suggesting current programmes do not meet the requirements of patients and their treating health professionals.The aim of this study was to seek the opinions of patients, vascular surgeons and accredited exercise physiologists (AEPs) in Australia regarding the value and optimal design of an exercise program