CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
127
From these data, quality of life in patients with both ASO and
Buerger’s disease was negatively affected after critical ischaemia
developed in the leg.
Results of VASCUQOL
Quality of life was evaluated with VASCUQOL at the time
of hospital admission, and at six and 12 months’ follow up.
Statistically significant differences were found between both
groups in terms of pain at the time of hospital admission.
Statistically significant differences were also found between both
groups in terms of pain, symptom level and social status at six
months (
p
=
0.008,
p
=
0.04,
p
=
0.02,
p
=
0.02, respectively).
Pain was observed to be more explicit and social status more
impaired in Buerger’s disease patients; however, this difference
disappeared at 12 months (Table 5).
VASCUQOL scores of patients with PAD (irrespective of
group) were compared according to the clinical categories of
chronic limb ischaemia (Rutherford classification
4
). Patients
whose category level was 5 and over were observed to be
significantly worse in terms of totalVASCUQOL score, symptom
level and social status at the time of the first admission, as well as
symptom level and social status at six months (Table 6).
In terms of total VASCUQOL score, when patients with
advanced PAD in only category 5 and over were compared with
patients with chronic ischaemia of category 5 and over, there
were no statistically significant differences between the groups
in at the time of hospital admission or at six and 12 months (
p
=
0.602,
p
=
0.347,
p
=
0.839, respectively) (data not presented).
Impact of amputation on quality of life
The impact of limb amputations within one year of hospital
admission on quality of life was evaluated. According to the
SF-36 score, at admission, amputation negatively affected pain
in patients with both ASO and Buerger’s disease (
p
=
0.003). The
amputation also negatively affected physical function, physical
status, pain, general health, social functions and emotional status
in these patients at six months (
p
=
0.002,
p
=
0.007,
p
=
0.001,
p
=
0.009,
p
=
0.005,
p
=
0.001, respectively) and at 12 months
(
p
=
0.002,
p
=
0.007,
p
=
0.001,
p
=
0.009,
p
=
0.005,
p
=
0.001,
respectively). Additionally, amputation was found to negatively
affect mental status in the ASO patients at 12 months (
p
=
0.011). The total VASCUQOL scores were significantly lower in
amputees with ASO and Buerger’s disease at six and 12 months
(
p
=
0.039,
p
=
0.001, respectively) than the SF-36 scores.
Difference in quality of life in ASO and Buerger’s disease
patients who were not amputees was evaluated. The total
VASCUQOL score was found to be lower in Buerger’s disease
patients at the time of hospital admission and at six months (
p
=
0.032,
p
=
0.005, respectively) than in ASO patients.
Difference in quality of life between amputees with
Buerger’s disease and ASO was also evaluated. No significant
differences in quality of life were observed at admission or at
six and 12 months in these groups (
p
=
0.84,
p
=
0.48,
p
=
0.32,
respectively). These results could have been related to the fact
that the source of pain had been amputated in these ASO and
Buerger’s disease patients, therefore no difference in quality of
life would be expected. However, quality of life was observed
to be significantly worse in non-amputee Buerger’s disease
patients than ASO patients.
Discussion
Peripheral arterial diseases are high-morbidity diseases that
have a negative effect on quality of life.
7-9
Although there are
numerous studies on quality of life in patients with PAD, or
comparing quality of life between patients with PAD and other
cardiovascular diseases,
10
to our knowledge, there is no study that
compares quality of life between the different categories of PAD,
Table 5. Evaluation of VASCUQOL between the groups.
Quality-of-life
variables
First evaluation
6-month follow up
12-month follow up
Atherosclerosis
(
n
=
47)
Buerger’s
disease (
n
=
39)
p
-value
Atherosclerosis
(
n
=
33)
Buerger’s
disease (
n
=
33)
p
-value
Atherosclerosis
(
n
=
22)
Buerger’s
disease (
n
=
25)
p
-value
Pain
2.6
±
0.2
1.8
±
0.1
0.008* 4.6
±
0.3
3.7
±
0.2
0.04*
5.2
±
0.5
5.0
±
0.4
0.74
Symptom
3.0
±
0.2
2.5
±
0.2
0.08
5.0
±
0.2
4.0
±
0.3
0.02*
5.5
±
0.4
5.4
±
0.3
0.82
Activity
2.2
±
0.1
2.1
±
0.2
0.81
4.5
±
0.3
3.9
±
0.3
0.20
5.3
±
0.4
4.7
±
0.4
0.36
Social status
3.0
±
0.2
2.6
±
0.2
0.17
4.6
±
0.3
3.7
±
0.2
0.02*
5.3
±
0.4
4.6
±
0.3
0.19
Emotional status
2.6
±
0.2
2.4
±
0.2
0.40
4.8
±
0.3
3.9
±
0.3
0.06
5.6
±
0.4
4.7
±
0.4
0.14
Values are median
±
SE.
p
-values are between the groups comparisons. *Statistically significant value.
Table 6. Evaluation of VASCUQOL according to category level
Quality-of-life
variables
First evaluation
6-month follow up
12-month follow up
Category
≤
4
(
n
=
36)
Category
≥
5
(
n
=
50)
p
-value
Category
≤
4
(
n
=
24)
Category
≥
5
(
n
=
43)
p
-value
Category
≤
4
(
n
=
22)
Category
≥
5
(
n
=
25)
p
-value
Pain
2.5
±
0.2
2.1
±
0.1
0.13
4.2
±
0.4
4.1
±
0.3
0.79
5.0
±
0.5
5.2
±
0.4
0.84
Symptoms
3.3
±
0.2
2.4
±
0.1
0.02*
5.0
±
0.2
4.3
±
0.2
0.04* 5.6
±
0.4
5.4
±
0.3
0.76
Activity
2.2
±
0.1
2.1
±
0.1
0.73
4.6
±
0.3
3.9
±
0.2
0.14
5.1
±
0.5
4.9
±
0.3
0.72
Social status
3.3
±
0.2
2.4
±
0.1
0.003* 4.7
±
0.3
3.8
±
0.2
0.03* 5.2
±
0.4
4.7
±
0.4
0.46
Emotional status
2.8
±
0.3
2.3
±
0.2
0.17
4.8
±
0.4
4.1
±
0.3
0.12
5.4
±
0.5
4.9
±
0.4
0.52
Total VASCUQOL 2.9
±
0.2
2.3
±
0.1
0.006* 4.7
±
0.3
4.1
±
0.2
0.13
5.2
±
0.4
5.0
±
0.3
0.63
Values are median
±
SE. *Statistically significant value.
