Health Expectations, Risk Tolerance, and Walking in Peripheral Artery Disease-Related Claudication

We examined the association between health expectations, baseline physical activity, and self-reported symptom severity among patients with claudication: calf pain that occurs during walking and is relieved at rest. Beliefs and attitudes toward exercise influence the behavior. When walking is prescribed as an alternative to surgical intervention with the intention of decreasing symptom severity, as is the case with claudication, it is important to assess patient perceptions, beliefs, and expectations. Through a phone survey, participants described the severity of their symptoms via the Walking Impairment Questionnaire. Data were collected on (1) health expectations and attitudes, assessments of value placed on recovery in the form of associated risks and benefits, and (2) daily physical activity (Physical Activity Scale for the Elderly, known as the PASE). Between February and August 2016, twenty participants were enrolled. The median age among the predominantly male cohort (19, 95%) was 69 years (interquartile range: 66–75 years). Most participants were “risk-seeking” in that 75% (12/16) were willing to accept the risk of amputation associated with surgery regardless of the level of symptom improvement. The alternative was walking, which is associated with no risk of amputation. Individuals who expected greater walking benefit reported walking greater distances with less difficulty (p = .04; unadjusted). Given that most participants were willing to accept some risk of amputation despite the equivalent effectiveness of exercise and surgery in treating claudication, understanding a patient’s perspective is critical to identifying the appropriate approach that will treat symptoms with the least adverse effects

Impact of cumulative intravascular contrast exposure on renal function in patients with occlusive and aneurysmal vascular disease

ObjectivePatients with occlusive or aneurysmal vascular disease are repeatedly exposed to intravascular (IV) contrast for diagnostic or therapeutic purposes. We sought to determine the long-term impact of cumulative iodinated IV contrast exposure (CIVCE) on renal function; the latter was defined by means of National Kidney Foundation (NKF) criteria.MethodsWe performed a longitudinal study of consecutive patients without renal insufficiency at baseline (NFK stage I or II) who underwent interventions for arterial occlusive or aneurysmal disease. We collected detailed data on any IV iodinated contrast exposure (including diagnostic or therapeutic angiography, cardiac catheterization, IV pyelography, computed tomography with IV contrast, computed tomographic angiography); medication exposure throughout the observation period; comorbidities; and demographics. The primary end point was the development of renal failure (RF) (defined as NFK stage 4 or 5). Analysis was performed with the use of a shared frailty model with clustering at the patient level.ResultsPatients (n = 1274) had a mean follow-up of 5.8 (range, 2.2-14) years. In the multivariate model with RF as the dependent variable and after adjusting for the statistically significant covariates of baseline renal function (hazard ratio [HR], 0.95; P < .001), diabetes (HR, 1.8; P = .007), use of an angiotensin-converting enzyme inhibitor (HR, 0.63; P = .03), use of antiplatelets (HR, 0.5; P = .01), cumulative number of open vascular operations performed (HR, 1.2; P = .001), and congestive heart failure (HR, 3.2; P < .001), CIVCE remained an independent predictor for RF development (HR, 1.1; P < .001). In the multivariate survival analysis model and after adjusting for the statistically significant covariates of perioperative myocardial infarction (HR, 3.9; P < .001), age at entry in the cohort (HR, 1.05; P = .035), total number of open operations (HR, 1.51; P < .001), and serum albumin (HR, 0.47; P < .001), CIVCE was an independent predictor of death (HR, 1.07; P < .001).ConclusionsCumulative IV contrast exposure is an independent predictor of RF and death in patients with occlusive and aneurysmal vascular disease

Factors Associated With Adherence to Claudication Therapy Among Veterans - The FAACT Study

Symptomatic leg pain or claudication due to peripheral artery disease can range from mild to severely limiting pain that significantly reduces walking distance. Treatments for claudication are twofold: (1) conservative management and (2) surgical intervention by way of stenting and/or balloon angioplasty. Studies have shown that both strategies are equally effective in improving walking abilities as well as quality of life over the long-term. With surgical intervention, there is the lure of immediate relief from symptoms, if successful. However, compared to exercise, there is a surgery-associated 4% risk of major lower extremity amputation in the long term. Despite the low-amputation risk and benefits of exercise, initiating exercise and ensuring compliance with recommendations remain challenging. Low adherence rates raise pertinent questions with respect to the reasons for adherence failure, and differences between those who walk and those who do not walk. Objectives of this cross-sectional study included: identifying predictive factors that are associated with walking, examining whether successful smoking cessation translated to walking behavior, and qualitatively describing perceptions of claudication among a cohort of Veterans. Between August and October 2017, 500 surveys were mailed to potential participants across the United States. Responses were received from 140 participants (28%). The median age among this cohort of Veterans was 69 years (66-73). Of 137 individuals, 47 (34%) indicated that they reserved a dedicated time to walk for exercise compared to 90 (61%) who did not walk for exercise. From this analysis, we report that the intertemporal choices of regular saving habits (OR: 8.79, [2.23-34.78]), complex-problem solving (OR: 0.12, [0.03, 0.45]), puzzle-solving, (OR: 5.34, [1.41, 20.17]) were predictors associated with walking behavior (current and previous). With respect to smoking cessation, 44% (61/140) of respondents indicated that they had successfully quit smoking. In examining whether previous smoking and current smoking, among a cohort of Veterans, could describe exercise behavioral and psychological profiles, we found that participants who reported current smoking were less likely to also report walking behavior (OR: 0.33, [0.12, 0.90]). Participants with a history of smoking were also future-oriented, and regular savers. Finally, from the results of a phone-based interview of 10 respondents, we propose strategies, although seemingly minor, that may increase the likelihood of community-based walking

Book of Abstracts: 2019 Health Equity Summer Research Summit Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 18th, 2019

Copyright © 2020 Harris. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialtie