RESUMO
BACKGROUND: Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication. METHODS AND RESULTS: PORTRAIT screened 3637 patients with an abnormal ankle-brachial index and new, or worsened, claudication symptoms from 16 peripheral arterial disease (PAD) specialty clinics in the United States, the Netherlands, and Australia between June 2, 2011, and December 3, 2015. Of the 1608 eligible patients, 1275 (79%) were enrolled. Before treatment, patients were interviewed to obtain their demographics, PAD symptoms and health status, psychosocial characteristics, preferences for shared decision-making, socioeconomic, and cardiovascular risk factors. Patients' medical history, comorbidities, and PAD diagnostic information were abstracted from patients' medical records. Serial information about patients' health status, psychosocial, and lifestyle factors was collected at 3, 6, and 12 months by a core laboratory. Follow-up rates ranged from 84.2% to 91%. Clinical follow-up for PAD-related hospitalizations and major cardiovascular events is ongoing. CONCLUSIONS: PORTRAIT systematically collected serial PAD-specific health status data as a foundation for risk stratification, comparative effectiveness studies, and clinicians' adherence to quality-based performance measures. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
Assuntos
Fármacos Cardiovasculares/uso terapêutico , Terapia por Exercício , Nível de Saúde , Claudicação Intermitente/terapia , Estudos Multicêntricos como Assunto/métodos , Avaliação de Resultados da Assistência ao Paciente , Doença Arterial Periférica/terapia , Projetos de Pesquisa , Procedimentos Cirúrgicos Vasculares , Idoso , Austrália , Fármacos Cardiovasculares/efeitos adversos , Terapia por Exercício/efeitos adversos , Feminino , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Claudicação Intermitente/psicologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Países Baixos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/psicologia , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
BACKGROUND: Varicose veins are a common condition. Presentations can range from those that are noticed incidentally to those causing significant symptoms. Management options range from conservative to surgical approaches, with many alternatives available that offer different advantages, disadvantages and long term outcomes. OBJECTIVE: To describe the natural history, assessment and management of varicose veins. DISCUSSION: Surgical or other intervention is only necessary in a small percentage of patients, and is seldom urgent, perhaps only in the setting of progressive thrombophlebitis. Duplex ultrasound has become an essential modality for diagnosis, treatment and follow up. All the current modalities of endoluminal and open surgical treatment have similar short term outcomes and risks. Appropriate surgical treatment has the best long term outcomes and evidence base. Treatment of choice, however, depends on many factors, including local expertise.