Health Composite Scores from the 12-item Short-Form Health Survey. Those randomized to the intervention group increased their 6-minute walk distance in meters significantly (357.4 to 399.8 vs 353.3 to 342.2 for those in the control group; mean difference, 53.5; P < .001). There were also increases in maximum treadmill walking time (intervention, 7.91 to 9.44 minutes vs control, 7.56 to 8.09 minutes; mean difference, 1.01 minutes; P ¼ .04). Accelerometer-measured physical activity over 7 days also increased in the intervention group vs the control group (P ¼ .03). There were also significant improvements in the Walking Impairment Questionnaire distance score (P ¼ .003) and Walking Impairment Questionnaire speed score (P ¼ .004).Comment: The study indicates that home-based exercise can be effective in patients with PAD. It does not indicate that home-based exercise has equal effectiveness to supervised exercise programs, because the two were not directly compared. Nevertheless, until supervised exercise becomes a benefit of insurance coverage, the data should encourage physicians to recommend home-based exercise therapy in their patients with PAD.
The pooled estimate of total mortality from rAAA is very high, although it has declined over the years. Most patients die outside hospital, and there is no surgical intervention in a considerable number of those who survive to reach hospital.
This trial did not show a significant difference in combined death and severe complications between EVAR and OR. Mortality for OR both in randomized patients and in cohort patients was lower than anticipated, which may be explained by optimization of logistics, preoperative CT imaging, and centralization of care in centers of expertise.
Concerning discrimination and calibration, the updated GAS most accurately predicted death after intervention for a RAAA. However, the updated GAS did not identify patients with a ≥95% predicted death rate, and therefore cannot reliably support the decision to withhold intervention.
EVAR may be more effective for rAAA, but its increased costs mean that it is unaffordable based on current standards of societal willingness-to-pay for health gains.
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