Association between depressive symptoms and health status outcomes in patients with symptomatic peripheral artery disease.

Introduction: Depressive symptoms frequently co-occur in peripheral artery disease (PAD) and are associated with adverse clinical outcomes. We examined the association between depressive symptoms upon PAD presentation and PAD-specific health status outcomes.

Methods: Patients with new or worsening claudication in the PORTRAIT registry (2011-2015) were included. Health status was assessed at baseline, 3, 6, and 12 months using the Peripheral Artery Questionnaire (PAQ). Baseline depressive symptoms were measured with the Patient Health Questionnaire (PHQ-8). A mixture repeated measures model was used to estimate health status over time. Interactions between symptoms, sex, and treatment (early invasive vs. non-invasive) were tested in a propensity-matched cohort.

Results: Of 1272 patients, 36.8 % had mild, moderate, or severe depressive symptoms. Baseline mean PAQ summary scores were lower in patients with no vs. severe symptoms (53.06 [95 % CI 48.98, 57.13) vs. 40.30 [95 % CI 33.21, 47.4), p < 0.001). PAQ scores significantly improved within three months across depression severity (+14.3 points [95 % CI 12.0, 16.5] for no vs. +24 [95 % CI 17.0, 30.9] for severe symptoms). PAQ scores stabilized after 3 months (12-month mean 69.64 [95 % CI 65.56, 73.71) for no vs. 67.20 [95 % CI 60.10, 74.29] for severe symptoms, p = 0.105). No interactions between depression severity, sex, or PAD treatment were found.

Conclusion: Patients with PAD and depressive symptoms have lower baseline health status than those without. Health status improved within three months of vascular specialty care and stabilized afterwards, regardless of depression severity. Further integration of depression management within PAD care is needed.