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Clinical evolution of patients with lower extremity peripheral artery disease during the COVID-19 pandemic (the
Giacomo Buso1,2, Stefano Lanzi1, André Berchtold3
1Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland.
Insights
The COVID-19 pandemic did not worsen outcomes for peripheral artery disease (PAD) patients, with some functional improvements observed. Continued monitoring and active lifestyles are crucial for PAD patients during health crises.
Area of Science:
- Vascular Medicine
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic disrupted chronic disease management and necessitated home confinement.
- The impact on outpatients with lower extremity peripheral artery disease (PAD) was previously unknown.
Purpose of the Study:
- To evaluate the clinical outcomes and functional status of PAD outpatients during the COVID-19 pandemic.
- To compare pandemic-period data with pre-pandemic data for PAD patients.
Main Methods:
- A single-centre, retrospective-prospective study involving 259 PAD patients.
- Assessment included Leriche-Fontaine PAD stage, ankle-brachial index (ABI), 6-minute walking tests, and treadmill tests.
- Major adverse cardiovascular and limb events (MACE and MALE) were recorded and compared between pandemic and pre-pandemic periods.
Main Results:
- PAD stage degradation was less likely during the pandemic (OR: 0.43).
- Patients showed improved pain-free walking time and reduced maximal pain intensity during pandemic-related assessments.
- Hospitalizations and elective limb revascularization rates decreased during the pandemic, with fewer non-fatal strokes reported.
Conclusions:
- Outpatients with PAD did not experience clinical deterioration during the pandemic compared to pre-pandemic.
- While functional capacity improved for some, adverse event rates remained significant.
- Encouraging active lifestyles and close monitoring is vital for PAD patients during future pandemics.
Abstract:
Background: The COVID-19 pandemic has led to significant disruptions in chronic disease care and forced people to stay at home. The effects of such issues on outpatients with lower extremity peripheral artery disease (PAD) remain unknown. Patients and methods: Single-centre, retrospective-prospective study conducted in a Swiss University Hospital. Patients with PAD were included between May 1 and July 31, 2020, with a follow-up visit at 12 months. Upon both visits, the Leriche-Fontaine PAD stage was recorded, and study participants underwent ankle-brachial index (ABI) calculation to assess limb perfusion. Functional capacities were assessed through the 6-minute walking and treadmill tests. Major adverse cardiovascular (MACE) and limb events (MALE) were recorded. Data collected during the pandemic were compared with the pre-pandemic period (January 1, 2019-April 30, 2020). Results: Overall, 259 patients were included. Mean age was 69 years and male sex was prevalent (69.1%). Odds of experiencing a degradation in PAD stage were lower during the pandemic than before (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.21-0.87; p = 0.018). No significant difference was found between periods in terms of ABI trends. Both pain-free walking time at treadmill test (p = 0.003) and maximal pain intensity at 6-minute walking test (p = 0.001) significantly improved during the pandemic. Compared with the pre-pandemic period, during the pandemic patients were hospitalized less frequently (p = 0.028) and were less likely to undergo elective limb revascularization (p<0.001). No significant difference was found between periods in terms of MALE (p = 0.311), whereas non-fatal strokes were less frequently reported during the pandemic (p = 0.043). Conclusion: In a cohort of outpatients with PAD, we found no evidence of clinical deterioration during the pandemic compared with the pre-pandemic period, though rates of adverse events were nonnegligible in both periods. In case of future pandemics, patients with PAD should be encouraged to maintain an active lifestyle while being closely monitored to avoid clinical worsening.
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