4006-776-356 出国就医服务电话

免费获得国外相关药品,最快 1 个工作日回馈药物信息

出境医 / 临床实验 / Lifestyle Modification Programme for Patients With Peripheral Arterial Disease

Lifestyle Modification Programme for Patients With Peripheral Arterial Disease

Study Description
Brief Summary:
This trial randomises patients with occlusive peripheral arterial disease, to be managed either by providing a 12-week structured lifestyle modification programme, or standard healthcare.

Condition or disease Intervention/treatment Phase
Peripheral Arterial Occlusive Disease Behavioral: Risk Factors Modification Programme Behavioral: Standard Healthcare Not Applicable

Detailed Description:

Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events.

Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease.

Because PAD represents a peripheral manifestation of atherosclerosis, most traditional and novel cardiovascular risk factors are strongly associated with this condition. Smoking, diabetes, hyperlipidaemia, hypertension, unhealthy diet, and physical inactivity were identified as significant modifiable risk factors that should be targeted for secondary prevention.

Atherosclerotic risk factor identification and modification plays an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. Because of the efficacy of these techniques, several expert committees have recommended their use in patients with PAD. Despite clear guidelines, several studies have shown that patients with PAD are routinely undertreated for these risk factors, which may contribute to high rates of morbidity and mortality.

Our trial will evaluate the impact of a 12-week, structured lifestyle and risk factor modification programme on medical and lifestyle risk factors modification, as well as on clinical vascular outcomes, among patients with peripheral arterial disease. We will compare these outcomes to that of standard healthcare traditionally provided to this high-risk patient group.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 208 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: This is a randomised, parallel group, active-control trial, with patients randomised in a 1:1 ratio
Masking: Double (Investigator, Outcomes Assessor)
Masking Description: Blinding of trial participants and care providers is not possible because of obvious differences between the interventions. However, the investigator, the outcomes assessor and statistician are blinded to treatment received.
Primary Purpose: Treatment
Official Title: The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme
Actual Study Start Date : June 1, 2018
Estimated Primary Completion Date : September 1, 2020
Estimated Study Completion Date : June 1, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: Risk Factors Modification Programme
  • Patients in the intervention arm will attend a 12-week intensive lifestyle programme.
  • The intervention includes weekly exercise class and educational workshops, serial blood pressure, body mass index, glucose and lipid measurements.

    • Weekly multidisciplinary team meetings and targeted and protocol pharmacotherapy to support lifestyle changes.
Behavioral: Risk Factors Modification Programme
12- week supervised risk factor modification programme derived from the Euroaction study standards

Active Comparator: Standard Healthcare
The control group will receive information and advice to the patients to modify their lifestyles but without providing a structured intervention or an individualised plan.
Behavioral: Standard Healthcare
Patients are advised to adjust lifestyle without the support of the structured supervised programme

Outcome Measures
Primary Outcome Measures :
  1. Lifestyle and medical risk factor modification [ Time Frame: at 12 weeks ]

    Achieving target Improvement in lifestyle risk factors. Target improvement will be considered if the patient achieves any one or more of the following:

    1. Smoking cessation
    2. Body mass index 20-25 (kg/m^2). BMI is calculated by dividing body weight in kilograms by the square of height in meters
    3. Glycosylated haemoglobin (HbA1c) less than 7%
    4. Total Cholesterol less than 5.0 mmol/L


Secondary Outcome Measures :
  1. Amputation free survival [ Time Frame: 1 year ]
    if the patient underwent a major amputation and level of amputation

  2. Re-intervention or stenosis rate [ Time Frame: 1 year ]
    Any re-intervention or stenosis among patients who already underwent vascular surgery

  3. Freedom from major adverse cardiovascular events (MACE) and major adverse limb events (MALE) [ Time Frame: 1 year ]
    If the patient developed a major adverse cardiovascular event (MACE) or major adverse limb event (MALE)

  4. Revascularisation-free survival [ Time Frame: 1 year ]
    if the patient underwent any revascularisation procedure

  5. Health related quality of life [ Time Frame: 1 year ]

    assessed using the Dartmouth Cooperative Information Project (COOP) charts at enrolment and after one year.

    The COOP charts measure six core aspects of functional status: physical fitness, feelings, daily activities, social activities, change in health, pain, and overall health. The instrument consists of six charts, referring to the above mentioned aspects of functioning. Each chart consists of a simple title, a question referring to the status of the patient and an ordinal five-point response scale illustrated with a simple drawing.

    Each item is rated on this five-point ordinal scale ranging from 1 (no limitation at all) to 5 (severely limited); for 'change in health' score 1 means 'much better' and score 5 'much worse'. The designers do not advocate summing the responses to gain a single index figure of health status.



Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Aged 18 years or more
  • Provide written informed consent
  • PAD: diagnosed by at least one of the following:

    • Ankle-brachial index of less than 0.90 in at least one lower extremity(10)
    • Toe brachial index of less than 0.609
    • Evidence of arterial occlusive disease in one lower extremity detected by duplex ultrasonography, computed tomographic angiography, or magnetic resonance angiography(10)
  • Symptomatic PAD (Rutherford category 2 and above(11)
  • Patients should have at least one of the following risk factors:
  • Blood pressure > 140/80 mmHg
  • Fasting Blood Sugar (FBS) >53 mmol/mol
  • HbA1c >7%
  • Total cholesterol >5 mmol/L
  • LDL cholesterol >2.6 mmol/L
  • Triglycerides >1.7 mmol/L
  • HDL <1.0 mmol/L in men and <1.2 mmol/L in women
  • Physical activity less 30 minutes for 5 days per week
  • BMI 25>kg/m2
  • Waist circumference >80 cm in women, and >94 cm in men.
  • Current smoker or exposure to tobacco in any form
  • Unhealthy diet, Mediterranean diet score less than 10 points

Exclusion Criteria:

  • Rutherford category zero or one(11)
  • Involvement in another clinical trial in the previous six months
  • Legal incapacity
  • Inadequate English language
  • Significant cognitive impairment or mental illness
  • Inadequate English language
  • Significant cognitive impairment or mental illness
  • Refusal to participate in a certain part of the intervention
  • Mental and physical inability to participate in the structured programme
  • Pregnant (confirmed by β-human chorionic gonadotropion (HCG) analysis).
  • Contraindication to anticoagulation and antiplatelet medications or any of the risk factors treatment.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Wael Tawfick, MB BcH,MRCSI + 35391542535 wael.tawfick@hse.ie
Contact: Sherif Sultan, MD, FRCSI +35391542534 sherif.sultan@hse.ie

Locations
Layout table for location information
Ireland
Department of Vascular Surgery, Western Vascular Institute, Galway University Hospital Recruiting
Galway, Ireland
Contact: Sherif Sultan, MD    +35391542534    sherif.sultan@hse.ie   
Contact: Wael Tawfick, MD    +35391542535    wael.tawfick@hse.ie   
Sponsors and Collaborators
Western Vascular Institute, Ireland
Investigators
Layout table for investigator information
Principal Investigator: Wael Tawfick, MB BcH,MRCSI Western Vascular Institute, Ireland
Principal Investigator: Sherif Sultan, MB BcH,MRCSI Western Vascular Institute, Ireland
Study Director: Marah Elfghi, MB BcH, MSc Western Vascular Institute, Ireland
Tracking Information
First Submitted Date  ICMJE February 15, 2019
First Posted Date  ICMJE May 2, 2019
Last Update Posted Date May 2, 2019
Actual Study Start Date  ICMJE June 1, 2018
Estimated Primary Completion Date September 1, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: April 29, 2019)
Lifestyle and medical risk factor modification [ Time Frame: at 12 weeks ]
Achieving target Improvement in lifestyle risk factors. Target improvement will be considered if the patient achieves any one or more of the following:
  1. Smoking cessation
  2. Body mass index 20-25 (kg/m^2). BMI is calculated by dividing body weight in kilograms by the square of height in meters
  3. Glycosylated haemoglobin (HbA1c) less than 7%
  4. Total Cholesterol less than 5.0 mmol/L
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: April 29, 2019)
  • Amputation free survival [ Time Frame: 1 year ]
    if the patient underwent a major amputation and level of amputation
  • Re-intervention or stenosis rate [ Time Frame: 1 year ]
    Any re-intervention or stenosis among patients who already underwent vascular surgery
  • Freedom from major adverse cardiovascular events (MACE) and major adverse limb events (MALE) [ Time Frame: 1 year ]
    If the patient developed a major adverse cardiovascular event (MACE) or major adverse limb event (MALE)
  • Revascularisation-free survival [ Time Frame: 1 year ]
    if the patient underwent any revascularisation procedure
  • Health related quality of life [ Time Frame: 1 year ]
    assessed using the Dartmouth Cooperative Information Project (COOP) charts at enrolment and after one year. The COOP charts measure six core aspects of functional status: physical fitness, feelings, daily activities, social activities, change in health, pain, and overall health. The instrument consists of six charts, referring to the above mentioned aspects of functioning. Each chart consists of a simple title, a question referring to the status of the patient and an ordinal five-point response scale illustrated with a simple drawing. Each item is rated on this five-point ordinal scale ranging from 1 (no limitation at all) to 5 (severely limited); for 'change in health' score 1 means 'much better' and score 5 'much worse'. The designers do not advocate summing the responses to gain a single index figure of health status.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Lifestyle Modification Programme for Patients With Peripheral Arterial Disease
Official Title  ICMJE The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme
Brief Summary This trial randomises patients with occlusive peripheral arterial disease, to be managed either by providing a 12-week structured lifestyle modification programme, or standard healthcare.
Detailed Description

Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events.

Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease.

Because PAD represents a peripheral manifestation of atherosclerosis, most traditional and novel cardiovascular risk factors are strongly associated with this condition. Smoking, diabetes, hyperlipidaemia, hypertension, unhealthy diet, and physical inactivity were identified as significant modifiable risk factors that should be targeted for secondary prevention.

Atherosclerotic risk factor identification and modification plays an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. Because of the efficacy of these techniques, several expert committees have recommended their use in patients with PAD. Despite clear guidelines, several studies have shown that patients with PAD are routinely undertreated for these risk factors, which may contribute to high rates of morbidity and mortality.

Our trial will evaluate the impact of a 12-week, structured lifestyle and risk factor modification programme on medical and lifestyle risk factors modification, as well as on clinical vascular outcomes, among patients with peripheral arterial disease. We will compare these outcomes to that of standard healthcare traditionally provided to this high-risk patient group.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
This is a randomised, parallel group, active-control trial, with patients randomised in a 1:1 ratio
Masking: Double (Investigator, Outcomes Assessor)
Masking Description:
Blinding of trial participants and care providers is not possible because of obvious differences between the interventions. However, the investigator, the outcomes assessor and statistician are blinded to treatment received.
Primary Purpose: Treatment
Condition  ICMJE Peripheral Arterial Occlusive Disease
Intervention  ICMJE
  • Behavioral: Risk Factors Modification Programme
    12- week supervised risk factor modification programme derived from the Euroaction study standards
  • Behavioral: Standard Healthcare
    Patients are advised to adjust lifestyle without the support of the structured supervised programme
Study Arms  ICMJE
  • Experimental: Risk Factors Modification Programme
    • Patients in the intervention arm will attend a 12-week intensive lifestyle programme.
    • The intervention includes weekly exercise class and educational workshops, serial blood pressure, body mass index, glucose and lipid measurements.

      • Weekly multidisciplinary team meetings and targeted and protocol pharmacotherapy to support lifestyle changes.
    Intervention: Behavioral: Risk Factors Modification Programme
  • Active Comparator: Standard Healthcare
    The control group will receive information and advice to the patients to modify their lifestyles but without providing a structured intervention or an individualised plan.
    Intervention: Behavioral: Standard Healthcare
Publications *
  • Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UK, Williams LJ, Mensah GA, Criqui MH. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013 Oct 19;382(9901):1329-40. doi: 10.1016/S0140-6736(13)61249-0. Epub 2013 Aug 1. Review.
  • Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, Powe NR, Siscovick D. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):538-45.
  • Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, Krook SH, Hunninghake DB, Comerota AJ, Walsh ME, McDermott MM, Hiatt WR. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001 Sep 19;286(11):1317-24.
  • Becker GJ, McClenny TE, Kovacs ME, Raabe RD, Katzen BT. The importance of increasing public and physician awareness of peripheral arterial disease. J Vasc Interv Radiol. 2002 Jan;13(1):7-11.
  • Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S. The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation. 1985 Mar;71(3):516-22.
  • Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006 Mar 21;113(11):e463-654. Review.
  • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.
  • Shen C, Li W. [Interpretation and consideration of the Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities management of asymptomatic disease and claudication]. Zhonghua Wai Ke Za Zhi. 2016 Feb 1;54(2):81-3. doi: 10.3760/cma.j.issn.0529-5815.2016.02.001. Chinese.
  • Lu JT, Creager MA. The relationship of cigarette smoking to peripheral arterial disease. Rev Cardiovasc Med. 2004 Fall;5(4):189-93. Review.
  • Mahé G, Kaladji A, Le Faucheur A, Jaquinandi V. Internal Iliac Artery Disease Management: Still Absent in the Update to TASC II (Inter-Society Consensus for the Management of Peripheral Arterial Disease). J Endovasc Ther. 2016 Feb;23(1):233-4. doi: 10.1177/1526602815621757.
  • Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997 Sep;26(3):517-38. Erratum in: J Vasc Surg 2001 Apr;33(4):805.
  • Elfghi M, Jordan F, Dunne D, Gibson I, Jones J, Flaherty G, Sultan S, Tawfick W. The effect of lifestyle and risk factor modification on occlusive peripheral arterial disease outcomes: standard healthcare vs structured programme-for a randomised controlled trial protocol. Trials. 2021 Feb 13;22(1):138. doi: 10.1186/s13063-021-05087-x.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Unknown status
Estimated Enrollment  ICMJE
 (submitted: April 29, 2019)
208
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE June 1, 2021
Estimated Primary Completion Date September 1, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Aged 18 years or more
  • Provide written informed consent
  • PAD: diagnosed by at least one of the following:

    • Ankle-brachial index of less than 0.90 in at least one lower extremity(10)
    • Toe brachial index of less than 0.609
    • Evidence of arterial occlusive disease in one lower extremity detected by duplex ultrasonography, computed tomographic angiography, or magnetic resonance angiography(10)
  • Symptomatic PAD (Rutherford category 2 and above(11)
  • Patients should have at least one of the following risk factors:
  • Blood pressure > 140/80 mmHg
  • Fasting Blood Sugar (FBS) >53 mmol/mol
  • HbA1c >7%
  • Total cholesterol >5 mmol/L
  • LDL cholesterol >2.6 mmol/L
  • Triglycerides >1.7 mmol/L
  • HDL <1.0 mmol/L in men and <1.2 mmol/L in women
  • Physical activity less 30 minutes for 5 days per week
  • BMI 25>kg/m2
  • Waist circumference >80 cm in women, and >94 cm in men.
  • Current smoker or exposure to tobacco in any form
  • Unhealthy diet, Mediterranean diet score less than 10 points

Exclusion Criteria:

  • Rutherford category zero or one(11)
  • Involvement in another clinical trial in the previous six months
  • Legal incapacity
  • Inadequate English language
  • Significant cognitive impairment or mental illness
  • Inadequate English language
  • Significant cognitive impairment or mental illness
  • Refusal to participate in a certain part of the intervention
  • Mental and physical inability to participate in the structured programme
  • Pregnant (confirmed by β-human chorionic gonadotropion (HCG) analysis).
  • Contraindication to anticoagulation and antiplatelet medications or any of the risk factors treatment.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 100 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Ireland
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03935776
Other Study ID Numbers  ICMJE WVI-PAD
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: Undecided
Plan Description: Individual patient data of primary and secondary outcomes, could be made available to other researchers by request, while maintaining participant confidentiality
Responsible Party Western Vascular Institute, Ireland
Study Sponsor  ICMJE Western Vascular Institute, Ireland
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Wael Tawfick, MB BcH,MRCSI Western Vascular Institute, Ireland
Principal Investigator: Sherif Sultan, MB BcH,MRCSI Western Vascular Institute, Ireland
Study Director: Marah Elfghi, MB BcH, MSc Western Vascular Institute, Ireland
PRS Account Western Vascular Institute, Ireland
Verification Date April 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP