Peripheral artery disease (PAD) is a chronic condition that affects 8.5 million adults in the United States. Although treatment for PAD has evolved over time, clinical evidence of how the disease affects patients’ mobility and quality of life is limited.
PAD is caused by narrowed or blocked blood arteries in the leg, which in severe cases can lead to tissue deterioration or limb amputation. Symptoms include muscle pain and ulcers, which affect mobility and quality of life. Patients are also prone to high blood pressure or diabetes and are therefore at high risk of heart attacks and premature death. A growing body of comparative efficacy research for various PAD therapeutics is still emerging.
To optimize the quality of vascular care and outcomes and to fill critical knowledge gaps, interventional cardiologist Carlos Mena-Hurtado, MD, Medical psychologist and outcomes researcher Kim G. Smolderen, PhD, launched one of the few programs in the country looking at vascular health outcomes. The Vascular Medicine OutcomeS (VAMOS) program at Yale University, an integral program supported by the Cardiovascular Center and Musculoskeletal Care Center of Yale New Haven Health, includes a global team of interventional cardiologists, vascular surgeons, podiatrists, radiologists and Allied Healthcare Professionals and Findings Researchers committed to transforming the way people diagnose and treat PAD and how patients access care.
The VAMOS program will address directly the needs of underserved populations, including minorities, who are disproportionately affected by PAD and who have more advanced, preventable complications. By building a network of multidisciplinary fields and specialties, including cardiovascular specialties, behavioral health, computer health, pharmacogenomics and many others, the VAMOS program offers a holistic means of shaping the supply of vascular populations.
Expertise in quality of life in vascular diseases: Findings from the PORTRAIT register
VAMOS researchers have built up years of expertise in assessing and analyzing the quality of life in vascular populations. For example, the PORTRAIT registry was created to address the need for an evidence-based PAD management model. PORTRAIT is led by the PI Kim Smolderen study along with a network of PAD specialists and represents many patients worldwide, including those at Yale New Haven Health. Researchers tracked more than 1,200 patients with a new or deteriorating diagnosis of PAD and tracked their quality of life. New evidence from the registry in the Journal of the American Heart Association shows that patients with depressive symptoms and PAD – especially women – had poorer recovery, as reflected in their health and quality of life one year after treatment.
A key aspect of VAMOS is patient-centered care, which is supported by the knowledge gained through research. “This is the first study to document how depressive symptoms can make PAD recovery difficult, even in patients receiving special treatment,” said lead study author Smolderen in the attached American Heart Association news release.
“A primary goal of PAD treatment is to improve patient health and quality of life,” said lead study author Qurat-Ul-Ain Jelani, MD, a clinical associate in cardiovascular medicine at Yale. Jelani added, “Failure to recognize or treat symptoms of depression can stand in the way of achieving optimal recovery.”
For this reason, partnerships with patients and their families form the basis of the VAMOS program. Empowering patients and understanding their perspectives is key. The research framework includes risk factors, clinical characteristics, psychological measures and socio-economic factors. In the Journal of Psychosomatic Research, Smolderen highlighted the prevalence of mental disorders in over a third of patients with PAD. Stress was a major contributor, especially after a recent diagnosis or an increase in symptom severity.
The variability in compliance with guidelines is also a key concern. Data published in the Journal of the American Heart Association showed that one in five patients who attended specialist clinics received adequate evidence-based interventions, including referrals to aid smoking cessation or efforts to increase physical activity.
One such study, published in the European Journal of Vascular and Endovascular Surgery, looked at differences in physical activity among patients with PAD in the United States and the Netherlands. The authors observed that US patients were more sedentary than their European counterparts. Dutch patients were far more likely to be referred to supervised exercise programs, which helped them adopt an active lifestyle.
Patient preferences for care and outcomes are essential to VAMOS. The clinical components prioritize relationships with the community to optimize care and emphasize the reach of underserved populations. This ensures that care is accessible and that the stories the team documents reflect different populations. “What is important to the patient is not always the same as what is important to us,” explained Mena. “We are looking at 30 day mortality. They care about how to go from their home to the bus stop when they don’t have suitable shoes. “
Future opportunities at VAMOS
The solution to these challenges includes mentoring to support trainees and young investigators. The VAMOS program enables world leaders in research into vascular outcomes to pursue clinical and research interests. The VAMOS team uniquely trains the next generation of executives in vascular outcome research. Trainees are exposed to the full spectrum of vascular disease, from carotid artery disease to lower extremity disease, including critical limb ischemia in a variety of registries, loss data, and clinical trial data.
Mahesh Anantha, MD, a peripheral vascular fellowship graduate, was selected as a finalist for the American Heart Association’s Jay D. Coffman Early Career Investigator Award for his summary, Trends in Hospital Admissions and Outcomes in Patients with Critical Limb ischemia. Analysis from a national database. “The Coffman Prize recognizes outstanding researchers in the field of peripheral vascular medicine.
The VAMOS program also wants to learn how trainees can adapt to the current pandemic. Dr. med. Samit Shah and Dr. Yulanka Castro-Dominguez co-authored a manuscript examining the impact of COVID-19 on interventional cardiology training in the United States and proposed strategies to minimize potential knowledge gaps.
Visit the website to learn how the VAMOS team can help improve vascular health outcomes.
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