Psychosocial and Socio-Economic Factors are Most Predictive of Health Status in Patients with Claudication.

BACKGROUND: As a key treatment goal for patients with symptomatic peripheral artery disease (PAD), improving health status has also become an important endpoint for clinical trials and performance-based care. An understanding of patient factors associated with 1-year PAD health status is lacking in patients with PAD.

METHODS: The health status of 1,073 consecutive patients with symptomatic PAD in the international multi-center PORTRAIT Registry was measured at baseline and 1-year with the Peripheral Artery Questionnaire (PAQ). The association of 47 patient characteristics with 1-year PAQ scores was assessed using a random forest algorithm. Variables of clinical significance were retained and included in a hierarchical multivariable linear regression model predicting 1-year PAQ summary scores.

RESULTS: The mean age of patients was 67.7 ± 9.3 years and 37% were female. Variables with the highest importance ranking in predicting 1-year PAQ summary score were baseline PAQ summary score, PHQ-8 depression score, GAD-2 anxiety score, new onset symptom presentation, insurance status, current or prior diagnosis of depression, low social support, initial invasive treatment, duration of symptoms, and race. The addition of 19 clinical variables in an extended model marginally improved the explained variance in 1-year health status (from R2 0.312 to 0.335).

CONCLUSIONS: Patients' 1-year PAD-specific health status as measured by the PAQ can be predicted from 10 mostly psychosocial and socio-economic patient characteristics including depression, anxiety, insurance status, social support, and symptoms. These characteristics should be validated and tested in other PAD cohorts so that this model can inform risk adjustment and prediction of PAD health status in comparative effectiveness research and performance-based care.