Disproportionately more women are affected by depression when pursuing specialty PAD care

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A disproportionately higher percentage of women are affected by depressive symptoms when they seek specialty care for new or worsening peripheral arterial disease (PAD) symptoms, with rates almost twice that observed in men, according to a new study published in the Journal of the American Heart Association (JAHA).

Qurat‐ul‐ain Jelani, MD, of the Vascular Medicine Outcomes Program at Yale University School of Medicine in New Haven, Connecticut, et al had hypothesized that women with PAD have a higher burden of depressive symptoms compared with men, both at baseline and in the year following a new or worsening diagnosis, and that depressive symptoms would be associated with worse health status outcomes over time.

Though depressive symptoms are known to be associated with such a more dramatic annual decline in functional performance, reduced walking distance and less quality‐of‐life benefit after revascularization, it is unclear to what extent depressive symptoms may be associated with a worse health status recovery profile in patients with PAD, and whether women are affected differently than men, the authors assert.

Known as the PORTRAIT (Patient‐centered outcomes related to treatment practices in peripheral artery disease: Investigating trajectories) registry—which was partially funded through a Patient‐Centered Outcomes Research Institute (PCORI) award and an unrestricted grant by Gore—the investigation took the form of a prospective, observational study designed to address gaps in knowledge about the quality of care and health status outcomes of patients with PAD.

Some 1,243 patients with new or worsening PAD symptoms were enrolled in the study between June 2011 and December 2015, and were derived from 16 vascular specialty clinics—10 in the United States, five in the Netherlands and one in Australia.

Depressive symptoms were assessed at baseline and three months using the eight‐item Patient Health Questionnaire (PHQ-8). A score ≥10 indicates clinically-relevant depressive symptoms. Meanwhile, disease‐specific and generic health status were measured by the Peripheral Artery Questionnaire (PAQ) and EQ‐5D Visual Analogue Scale at baseline and three, six and 12 months.

The mean age of the patients was 67.6 years, with 38% of them women (n=470). A total of 199 patients (16.0%) had moderate–severe depressive (PHQ‐8 ≥10) symptoms on presentation. More % women than men (21.1% vs. 12.9%; p<0.001) presented with severe depressive symptoms. In the adjusted model, patients with depressive symptoms had worse health status at each time point (all p<0.0001). Results were similar for EQ‐5D scores. The magnitude in one‐year change in health status scores did not differ by sex. Depressive symptoms explained 19% of the association between sex differences in one‐year PAQ summary scores, the authors noted.

“Having a depressed mood has potentially major implications for the success of patients’ PAD rehabilitation process and their PAD functioning over time,” they write. “Depressive symptoms marked a suboptimal PAD recovery pathway, with differences as large as 16 to 21 points on the PAQ summary scale one year following active PAD treatment, differences that are almost twice the minimally clinically important difference, as defined from the patients’ perspective.”

The researchers noted limitations to their investigation, including the fact the cohort studied included patients seen at vascular specialty clinics—therefore, they comment, potentially unrepresentative of the general PAD population who may

not have access to specialty clinics. Concluding, they cite a set of findings that indicate the burden of depressive symptoms in PAD as being substantial, with affected patients, particularly women, having a “distinctly worse PAD‐specific health status” after specialty care. The authors say there is a need to explore mechanisms of this increased vulnerability in women.

They add: “Depressive symptoms in older, chronic disease populations, such as PAD, should be a continuous focus of its multidisciplinary treatment so as to ensure quality PAD care and optimize outcomes.”

SOURCE: DOI.ORG/10.1161/JAHA.119.014583

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