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CLINICAL RESEARCH: PERIPHERAL ARTERY DISEASE

Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease

Mary M. McDermott, MD^_*,,_*, Lu Tian, ScD, Kiang Liu, PhD, Jack M. Guralnik, MD, PhD, Luigi Ferrucci, MD, PhD^||, Jin Tan, MS, William H. Pearce, MD, Joseph R. Schneider, MD, PhD^,¶ and Michael H. Criqui, MD, MPH^#

^_* Department of Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois
Department of Preventive Medicine, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois
Department of Surgery, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois
Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland
^|| Laboratory of Clinical Epidemiology, National Institute on Aging, Bethesda, Maryland
^¶ Department of Surgery, Evanston Northwestern Hospital, Evanston, Illinois
^# Department of Family and Preventive Medicine, University of California at San Diego, San Diego, California.

Manuscript received September 4, 2007; revised manuscript received December 3, 2007, accepted December 5, 2007.

^_* Reprint requests and correspondence: Dr. Mary M. McDermott, 750 North Lake Shore Drive, 10th Floor, Chicago, Illinois 60611. (Email: mdm608{at}northwestern.edu).

Objectives: Among persons with lower extremity peripheral artery disease (PAD), we determined whether objective measures of walking performance predict mortality independently of the ankle brachial index (ABI).

Background: The ability of office-based functional performance measures to predict mortality in patients with PAD is unknown.

Methods: Participants were 444 persons with PAD followed prospectively for 4.8 years. The 6-min walk and 4-m walks at usual and fastest pace were measured at baseline. Cox proportional hazard models were used to assess relations between baseline measures of lower extremity performance with mortality, adjusting for confounders.

Results: One hundred twenty-seven patients (28.6%) died during follow-up. Adjusting for age, gender, race, comorbidities, ABI, and other confounders, participants in the poorest baseline quartile of 6-min walk performance had significantly increased total mortality (hazard ratio [HR] 2.36 [95% confidence interval (CI) 1.33 to 4.18]) and cardiovascular mortality (HR 5.59 [95% CI 1.97 to 15.9]) compared with the best quartile of baseline performance. Participants in the poorest baseline quartile of normal-paced 4-m walking speed had significantly increased total mortality (HR 1.86 [95% CI 1.06 to 3.29]) and cardiovascular mortality (HR 2.55 [95% CI 1.01 to 6.46]) compared with the best quartile of baseline performance.

Conclusions: This study demonstrates for the first time that performance-based measures, which can be administered in an office setting, provide prognostic information regarding mortality in persons with PAD beyond that provided by the ABI.

Abbreviations and Acronyms   ABI = ankle brachial index   BMI = body mass index   PAD = peripheral artery disease   SPPB = short physical performance battery

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