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Depression Hampers PAD Treatment

Greater assessment and treatment efforts needed

Peripheral artery disease (PAD) patients who are depressed benefit less from peripheral endovascular intervention, according to a study published recently in Vascular Medicine.

It was established that depression compromises the health of patients with heart failure and coronary artery disease, but there was little information regarding the PAD population. Because of PAD’s prevalence, the authors of the current study sought answers. They used data from the Assessment of Lower Extremity rEvascularization outcomEs (ALEVE) study, a single-center, prospective, observational cohort study. Participants had either intermittent claudication (97 percent) or critical limb ischemia. They underwent peripheral angiography and percutaneous transluminal angioplasty (PTA), and the researchers collected detailed chart information and performed standardized patient interviews, both at baseline and at one year. Depression was assessed with an abbreviated form of the Primary Care Evaluation of Mental Disorders questionnaire, which has a sensitivity of 88 percent and a specificity of 88 percent. PAD-related health status was assessed with the Peripheral Artery Questionnaire, which has subscales regarding physical limitations, symptoms, symptom stability, treatment satisfaction, quality of life, and social functioning.

Eighty percent of participants were treated with bare metal stents in addition to PTA. All patients improved after PTA, but those with persistent or worsened depression benefited significantly less than those without symptoms. Depressed patients may perceive their disease or treatment benefits differently, the authors write. The mechanism behind this effect is unknown; depression may reflect disease burden, or it may be a mediator of worse outcomes, independent of disease severity. The authors conclude that more study is needed and, “vascular surgeons, interventionists, and other clinicians involved in PAD management can facilitate depression recognition by incorporating quality of care initiatives that promote depression recognition and appropriate follow-up for these at-risk patients.”

Source: Smolderen KG, Safley DM, House JA, et al. 2011. Percutaneous transluminal angioplasty: association between depressive symptoms and diminished health status benefits. Vascular Medicine 16(4):260-266.