Defining patient goals for therapy in peripheral artery disease: A need for collaborative science

Hogan, Shea E; Coylewright, Megan

doi:10.1177/1358863x241295728

Vasc Med

2024

DOI: 10.1177/1358863x241295728

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Defining patient goals for therapy in peripheral artery disease: A need for collaborative science

Shea E Hogan,

Megan Coylewright

Abstract: Commentary on Reed et al. Quantifying patients' preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication.

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Quantifying patients’ preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication

Reed,

Sutphin,

Wallace

et al. 2024

Vasc Med

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Background: In 2019, the US Food and Drug Administration issued a warning that symptomatic relief from claudication using paclitaxel-coated devices might be associated with an increase in mortality over 5 years. We designed a discrete-choice experiment (DCE) to quantify tradeoffs that patients would accept between a decreased risk of clinically driven target-vessel revascularization (CDTVR) and increased mortality risk. Methods: Patients with claudication symptoms were recruited from seven medical centers to complete a web-based survey including eight DCE questions that presented pairs of hypothetical device profiles defined by varying risks of CDTVR and overall mortality at 2 and 5 years. Random-parameters logit models were used to estimate relative preference weights, from which the maximum-acceptable increase in 5-year mortality risk was derived. Results: A total of 272 patients completed the survey. On average, patients would accept a device offering reductions in CDTVR risks from 30% to 10% at 2 years and from 40% to 30% at 5 years if the 5-year mortality risk was less than 12.6% (95% CI: 11.8–13.4%), representing a cut-point of 4.6 percentage points above a baseline risk of 8%. However, approximately 40% chose the device alternative with the lower 5-year mortality risk in seven (20.6%) or eight (18.0%) of the eight DCE questions regardless of the benefit offered. Conclusions: Most patients in the study would accept some incremental increase in 5-year mortality risk to reduce the 2-year and 5-year risks of CDTVR by 20 and 10 percentage points, respectively. However, significant patient-level variability in risk tolerance underscores the need for systematic approaches to support benefit-risk decision making.

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Quantifying patients’ preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication

Reed,

Sutphin,

Wallace

et al. 2024

Vasc Med

View full text Add to dashboard Cite

show abstract

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Defining patient goals for therapy in peripheral artery disease: A need for collaborative science

Abstract: Commentary on Reed et al. Quantifying patients' preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication.

Cited by 1 publication

References 12 publications

Quantifying patients’ preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication

Quantifying patients’ preferences on tradeoffs between mortality risk and reduced need for target vessel revascularization for claudication

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