The Evolution of Patient-Centric Care in PAD, with Aruna Pradhan, MD, MPH

Aruna Pradhan, MD, MPH

The American Heart Association’s scientific statement on patient-reported outcomes (PROs) in the care of patients with peripheral artery disease (PAD) is significant, not just for populations with PAD, but cardiology as a whole.

Decades ago, some would have thought the idea of incorporating PROs into clinical decision-making was laughable. Now, the evolution and validation of PROs and patient-reported outcome measures (PROMs) have made their inclusion in care essential for optimal management of PAD, according to nation’s oldest cardiology organization.

A 12-page document written on behalf of the AHA’s Council on Peripheral Vascular Disease and Council on Lifestyle and Cardiometabolic Health, the document shines a spotlight on considerations for inclusions of PROs and PROMs into clinical care of patients with PAD Published in Circulation, the document also shines a spotlight on the development and validation process of PROs and PROMs as well as future considerations for further development of PROMs and PRO-Based performance measures for advancing the quality of care for this patient population.

While on-site at Physicians’ Education Resource’s6th Annual Cardo-Endo-Renal Collaborative, Practical Cardiology sat down with Aruna Pradhan, MD, MPH, associate professor of medicine at Harvard Medical School and clinical cardiologist at VA Boston Health Care System who presented on social determinants of health in PAD at the meeting, for further perspective on the statement from the viewpoint of a practicing clinician.

Practical Cardiology: How has the evolution and validation of PROs impacted the care of PAD in recent years?

Pradhan: I would say that many of the measures that are included in the scientific statement from the American Heart Association on patient-reported outcomes in patients with PAD use measures that have been around for quite a while. The PHQ-9 depression score, the VascuQoL, the WIQ, and a few others that have really been around and that do apply quite nicely to patients with PAD. What is important is that the types of PRO measures that are used are calibrated to that population so the ranges that you get back on a measure fit the population that you're applying to measure to.

This is to prevent getting all zeros or all hundreds you are left with no ability to make a change with your intervention. So, you want the measures to apply to the population. We're lucky that we have PRO measures that actually work in this population.

Practical Cardiology: The evolution of incorporating has mostly occurred within the past decade, whereas, decades ago, few would have considered incorporating PROs into clinical care. Can you provide perspective on what this has been like as a practicing clinician in the field?

Pradhan: So, I've been practicing for about 20 years. So, in that 10-year time frame, after I had finished fellowship, the idea was sort of new to me and to cardiology as well. In the past, there was usually a distance that was maintained in order to maintain respect and a certain level trust. The level of trust that we're now talking about with patients is a different type of trust. It's actually one that's a bit more invasive and interactive.

It is challenging for some of us who trained in that era to adopt, but as I was listening to the talks today, I'm also feeling that if we don't start using this terminology and if we don't start feeling uneasy, we'll never get over it to a point where it becomes normalcy. So, I'm really glad that the field has shifted.

Editor’s note: This transcript has been edited for length and clarity.

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