FUNCTIONAL AND HEALTH STATUS OF PATIENTS WITH A PERIPHERAL ARTERIAL DISEASE: ONE-YEAR OBSERVATION

UVOD Prevalenca periferne arterijske bolezni (PAB) je visoka, zlasti asimptomatske. Tudi asimptomatska bolezen pomeni večje tveganje za srčno-žilno umrljivost in srčno-žilne dogodke. Kakovost življenja je pri bolnikih s PAB zmanjšana zlasti pri simptomatskih bolnikih. Na primarnem nivoju imamo enostavno metodo za odkrivanje periferne arterijske bolezni. To je merjenje gleženjskega indeksa, ki ima visoko specifičnost in senzitivnost. Mnogi splošni vprašalniki o kakovosti življenja so bili preizkušeni tudi pri PAB. COOP/WONCA je eden izmed splošnih vprašalnikov funkcijskega stanja, ki je bil preizkušen za mnoge kronične bolezni, pri PAB pa ni bil preizkušen. CILJI Namen raziskave je bil ugotoviti funkcijsko stanje bolnikov s PAB in ga primerjati s skupino obiskovalcev ambulante, ki imajo normalen gleženjski indeks. Cilj je bil tudi ugotoviti, kateri dejavniki vplivajo na funkcijsko stanje. Najpomembnejši cilj raziskave pa je bilo spremljanje enoletne umrljivosti, zbolevnosti in spremembe funkcijskega stanja. METODE IN PREISKOVANCI Ta naloga je del širše raziskave o PAB imenovane PID-PAB. Raziskava je bila prospektivna opazovalna in reprezentativna za Slovenijo. Zbirali so se osnovni demografski podatki o bolnikih, dejavniki tveganja in podatki o srčno-žilnih boleznih, gleženjskem indeksu, kliničnem statusu in laboratorijskih izvidih. Vsi so izpolnili vprašalnik COOP/WONCA. Po enem letu so se podatki ponovno zbrali. Opazovali smo umrljivost, trde in mehke dogodke. REZULTATI 85 zdravnikov je vključilo 827 bolnikov s PAB in 789 kontrol. Funkcijsko stanje bolnikov s PAB je bilo v vseh vidikih (telesno počutje, čustva, vsakodnevna opravila, družabno življenje in splošno stanje) in skupni oceni statistično značilno slabše kot v kontrolni skupini. Med dejavniki, ki vplivajo na funkcijsko stanje, so bili najpomembnejši: težave s spanjem, zmerno gibanje, število zdravil, gleženjski indeks, razdražljivost, intenzivno gibanje in hemoglobin. Pri dobri polovici bolnikov se funkcijsko stanje v enem letu opazovanja ni spremenilo. Za celoten vzorec se je poslabšalo le pri telesnem počutju, vsakodnevnih aktivnostih in skupni oceni COOP/WONCA, vendar le pri telesnem počutju statistično značilno. Pri vseh ostalih vidikih se je funkcijsko stanje pri več bolnikih izboljšalo kot poslabšalo. Izhodiščna skupna ocena COOP/WONCA ne napoveduje umrljivosti v enem letu opazovanja. Napoveduje pa trde posege, predvsem srčno kap in posege, posege na koronarnih in perifernih arterijah. Skupina bolnikov s PAB je imela v primerjavi s kontrolno skupino več posegov, zlasti posegov na koronarnih in perifernih arterijah. Statistično pomembnih razlik med skupinama pa ni bilo v umrljivosti in pri trdih dogodkih. ZAKLJUČKI Med skupinama so pomembne razlike v funkcijskem stanju, ki pa se po enem letu ne spremenijo bistveno. Prav tako ni razlike v umrljivosti v trdih dogodkih v enem letu opazovanja, zato je potrebno večletno opazovanje.BACKGROUND The prevalence of peripheral arterial disease (PAB) is high, particularly asymptomatic. Patients with an asymptomatic disease have increased a risk of cardiovascular mortality and cardiovascular events. Patients with PAD, particularly symptomatic patients, have worse quality of life. At the primary level, we have a simple method for the detection of PAD. Ankle-brachial index is a measure with high specificity and sensitivity. Many general questionnaires on quality of life were used for PAB. COOP/WONCA is one of the general functional status questionnaires, which have been used for many chronic diseases, but not for PAB. AIMS The aim of this study was to assess the functional status of patients with PAB and to compare them with a group of patients who have normal ankle-brachial index. The second objective was to determine which factors affect functional status. The main aim of the study was a year follow-up regarding mortality, morbidity and functional status changes. METHODS AND MATERIALS This study is a part of a wider research project on PAB called PID-PAB. The study was a prospective observational and representative for Slovenia. The basic demographic data of patients, risk factors and information on cardiovascular diseases, ankle-brachial index, clinical status and laboratory results were collected. A questionnaire COOP/WONCA was completed by all participants. After a year, the data were collected again. Mortality, hard and soft events were observed. RESULTS 85 physicians included 827 patients with PAB and 789 controls. The functional status of patients with PAB was in all aspects (physical fitness, emotions, everyday activities, social activities and general health) and in the sum score significantly worse than in the control group. The most important factors, having an impact on functional status, were: sleep problems, moderate exercise, the number of medicines, ankle-brachial index, irritability, intense exercise and haemoglobin. The functional status of more than a half of patients did not change within one-year observation. For the full sample only physical fitness, daily activities and sum score deteriorated, but only in physical fitness statistically significant. In all other aspects of the functional status more patients improved than deteriorated. The initial overall assessment of COOP/WONCA did not predict mortality within one-year observation. It predicted the hard events, particularly myocardial infarction and revascularisations, mostly in coronary and peripheral arteries. The group of patients with PAB compared to the control group had more revascularisations, particularly in coronary and peripheral arteries. There was no statistical difference between groups regarding death and hard events. CONCLUSIONS There are significant differences in the functional status among the groups. In a year functional status did not change significantly. Also, there is no difference in mortality in hard events within one-year observation. Therefore, more years of observation are needed