Determinants of poor health-related quality of life in people with peripheral arterial disease in Nepal

Introduction

Peripheral arterial disease (PAD) is a chronic arterial occlusive disease. It increases mortality risk by three to fivefolds and reduces health-related quality of life (HQoL). However, research on this topic in low-income settings is scarce. Therefore, this study aimed to assess the HQoL of patients with PAD and the factors influencing it in adults residing in Nepal.

Methods

This cross-sectional study included patients being reviewed at the Cardio Thoracic and Vascular Surgery Outpatient Department (CTVS OPD) or admitted to the surgical ward of Dhulikhel Hospital with the diagnosis of PAD. Patients were admitted for peripheral angiogram with or without angioplasty. Participants were selected with convenience sampling. We interviewed participants using socio demographic and SF 36 questionnaires to collect required information with their informed consent. Collected data were analyzed in SPSS version 21. Descriptive statistics and multivariable regression analysis was conducted to identify the predicting factors of health-related quality of life among the participants with PAD.

Results

A total of 96 participants with the diagnosis of PAD were interviewed for the study. The mean age of the participants was 56.19 (11.54) years. After adjusting for socio-demographic variables, presence of comorbidity, and smoking history, the study found significant associations between health conditions and various domains of health-related quality of life. Individuals with comorbidities had significantly lower physical function scores compared to those without comorbidities (mean difference = -9.9; p = 0.01; 95 % CI: -18.2 to -1.7). Participants with lower limb involvement had an 18.8-unit lower physical function score than those with an upper limb affected (p < 0.01; 95 % CI: -27.6 to -10.02). Role limitation due to physical health was 13.4 units higher among females compared to males (p = 0.009; 95 % CI: 3.4 to 23.5), and 21.7 units higher among those with secondary education or above compared to illiterate participants (p = 0.01; 95 % CI: 8.6 to 34.8). General health scores were significantly lower among those with comorbidities (mean difference = -5.3; p = 0.03; 95 % CI: -10.4 to -0.35). Compared to individuals with a single upper limb affected, those with upper limb involvement exhibited a 7.9-unit reduction in energy/fatigue scores (p = 0.01; 95 % CI: -14.2 to -1.6). Female participants experienced greater emotional role limitations than males, with a 10.4-unit decrease in score (p = 0.02; 95 % CI: -19.8 to -1.1). Additionally, individuals with comorbidities had significantly lower emotional wellbeing scores compared to those without, with an 8.3-unit reduction (p = 0.02; 95 % CI: -15.4 to -1.2).

Conclusion

In conclusion, the study highlights the substantial impact of comorbidities, gender, educational level, and the location of limb involvement on various aspects of health-related quality of life. Comorbid conditions were consistently associated with poorer outcomes across multiple domains, including physical function, general health, and emotional wellbeing. Female participants and those with higher educational attainment reported greater role limitations, while lower limb involvement and upper limb impairment were linked to more pronounced declines in physical function and energy levels. These findings underscore the need for tailored interventions that address both clinical and socio-demographic factors to improve quality of life in affected individuals.