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International Angiology 2003 September;22(3):290-301


language: English

The role of comorbidity burden for patients with symptomatic peripheral arterial disease (PAD). A quantitative approach

Kügler C., Rudofsky G.

Department and Clinic of Angiology, University of Essen, Essen, Germany


Aim. Comor­bid­ity will play an increas­ing­ly impor­tant role in PAD man­age­ment. There­fore, we aimed 1) to ­address the comor­bid­ity load of PAD ­patients quan­ti­ta­tive­ly and com­pre­hen­sive­ly, 2) to delin­eate the ­effects of com­pos­ite comor­bid­ity meas­ures on gen­er­al and dis­ease-spe­cif­ic ­aspects of qual­ity of life and on crude mark­ers of ­resource allo­ca­tion.
Meth­ods. One hun­dred and one con­sec­u­tive symp­to­mat­ic PAD ­patients (80 males, 21 ­females; mean age: 66.4±9.1 years) were ­assessed by means of a cumu­la­tive ill­ness rat­ing scale (CIRS: 14 items; indi­vid­u­al item rat­ing from 1 for no ­through 5 for life-threat­en­ing impair­ment). Out­come meas­ures were the ill­ness sever­ity score (CIRS-IS, mean of all sin­gle item ­scores) and the comor­bid­ity index (CIRS-CI, num­ber of sin­gle items with a score of 3, 4 or 5). These comor­bid­ity indi­ces of the PAD ­patients were com­pared with those of both 89 eld­er­ly com­mu­nity-dwell­ing vol­un­teers (44 males, 45 ­females, mean age 77.4± 5.3 years) we had inves­ti­gat­ed pre­vi­ous­ly and 439 ger­i­at­ric res­i­dents (121 males, 318 ­females; mean age 84.1±5.7 years) report­ed by Par­me­lee et al. in 1995. Fur­ther­more, the PAD ­patients esti­mat­ed their qual­ity of life (LQ), sub­jec­tive ­health stat­us (HS), leg pains dur­ing ­either rest or walk­ing on rat­ing ­scales (rang­ing from 0 for the best to 10 for the worst ­result).
­Results. PAD ­patients ­showed very high comor­bid­ity indi­ces and ill­ness sever­ity ­scores (CIRS-CI: 3.98±1.60; CIRS-IS: 1.86±0.29). These ­proved to be great­er than those of both fit com­mu­nity-dwell­ing eld­er­ly sub­jects (CIRS-CI: 1.82±1.46; CIRS-IS: 1.62±0.22) and older insti­tu­tion res­i­dents (CIRS-CI: 2.17±1.85; CIRS-IS: 1.64±0.34). Fur­ther­more, both CIRS-CI and CIRS-IS were sig­nif­i­cant­ly great­er in ­patients with more ­advanced PAD stage. These indi­ces of comor­bid­ity load were also asso­ciat­ed with qual­ity-of-life impair­ments (r=0.253, p=0.0186), ­degree of ischem­ic rest pain (r=0.251, p=0.0196), ­extent of med­i­ca­tion usage (r=0.511, p<0.0001) as well as dura­tion of in-hos­pi­tal stay (r=0.271, p=0.0084).
Con­clu­sion. PAD ­patients have a mark­ed­ly ­increased comor­bid­ity bur­den. This was great­er in the more ­advanced PAD stag­es and sig­nif­i­cant­ly asso­ciat­ed with qual­ity-of-life reduc­tions and the ­extent of ­resource allo­ca­tion. A quan­ti­ta­tive ­approach to the comor­bid­ity load in PAD ­patients ­appears to be pos­sible by means of such a scale and use­ful for both clin­i­cal and soci­oec­o­nom­ic pur­pos­es.

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