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Makowski L, Engelbertz C, Köppe J, Dröge P, Ruhnke T, Günster C, Gerß J, Freisinger E, Malyar N, Reinecke H, Feld J. Contemporary Treatment and Outcome of Patients with Ischaemic Lower Limb Amputation: A Focus on Sex Differences. Eur J Vasc Endovasc Surg 2023; 66:550-559. [PMID: 37355161 DOI: 10.1016/j.ejvs.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Chronic limb threatening ischaemia (CLTI) has a devastating prognosis with high rates of lower limb amputation (LLA) and deaths. This is an illustration of contemporary management and the long term fate of patients after ischaemic LLA, particularly with respect to sex, using real world data. METHODS This was a multisectoral cross sectional and longitudinal analysis of health claims data from the largest German health insurance database (AOK). Data of 39 796 propensity score matched patients hospitalised for ischaemic LLA between 2010 and 2018 were analysed for cardiovascular comorbidities, treatment, and for subsequent cardiovascular and limb events, with a distinct focus on sex. Matching was performed, to ensure that the rate of major amputations and the age distribution were equal in both groups (in both sexes). An observation period of two years before index and a follow up (FU) period until 2019 were included. RESULTS Before index amputation, 68% of patients had received any kind of peripheral revascularisation. The use of statins (37.0% vs. 42.6%) and antithrombotic substances (54.9% vs. 61.8%) was lower in women than in men (p < .001). During two year FU, cardiovascular and limb events occurred among women and men as follows: limb re-amputation (26.7% vs. 31.2%), myocardial infarction (10.9% vs. 14.5%), stroke (20.8% vs. 20.7%), and death from any cause (51.0% vs. 53.3%, p < .001 except for stroke). After adjustment for cardiovascular comorbidities and vascular procedures, female sex was associated with a higher probability of death (HR 1.04, 95% CI 1.04 - 1.04). CONCLUSION Patients undergoing ischaemic LLA still have a poor prognosis marked by high rates of recurrent cardiovascular and limb events resulting in a > 50% mortality rate within two years. The continuous lack of guideline recommended therapies, particularly in women, may be associated with the persisting poor outcome, necessitating urgent further investigation.
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Affiliation(s)
- Lena Makowski
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
| | - Christiane Engelbertz
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Köppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | | | | | | | - Joachim Gerß
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Nasser Malyar
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jannik Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
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Ryu GW, Park YS, Kim J, Yang YS, Ko YG, Choi M. Incidence and Prevalence of Peripheral Arterial Disease in South Korea: Retrospective Analysis of National Claims Data. JMIR Public Health Surveill 2022; 8:e34908. [PMID: 36399371 PMCID: PMC9719060 DOI: 10.2196/34908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) causes blood vessel narrowing that decreases blood flow to the lower extremities, with symptoms such as leg pain, discomfort, and intermittent claudication. PAD increases risks for amputation, poor health-related quality of life, and mortality. It is estimated that more than 200 million people worldwide have PAD, although the paucity of PAD research in the East detracts from knowledge on global PAD epidemiology. There are few national data-based analyses or health care utilization investigations. Thus, a national data analysis of PAD incidence and prevalence would provide baseline data to enable health promotion strategies for patients with PAD. OBJECTIVE This study aims to identify South Korean trends in the incidence and prevalence of PAD and PAD treatment, in-hospital deaths, and health care utilization. METHODS This was a retrospective analysis of South Korean national claims data from 2009 to 2018. The incidence of PAD was determined by setting the years 2010 and 2011 as a washout period to exclude previously diagnosed patients with PAD. The study included adults aged ≥20 and <90 years who received a primary diagnosis of PAD between 2011 and 2018; patients were stratified according to age, sex, and insurance status for the incidence and prevalence analyses. Descriptive statistics were used to assess incidence, prevalence, endovascular revascularization (EVR) events, amputations, in-hospital deaths, and the health care utilization characteristics of patients with PAD. RESULTS Based on data from 2011 to 2018, there were an average of 124,682 and 993,048 incident and prevalent PAD cases, respectively, in 2018. PAD incidence (per 1000 persons) ranged from 2.68 to 3.09 during the study period. From 2012 to 2018, the incidence rate in both sexes showed an increasing trend. PAD incidence continued to increase with age. PAD prevalence (per 1000 persons) increased steadily, from 3.93 in 2011 to 23.55 in 2018. The number of EVR events varied between 933 and 1422 during the study period, and both major and minor amputations showed a decreasing trend. Health care utilization characteristics showed that women visited clinics more frequently than men, whereas men used tertiary and general hospitals more often than women. CONCLUSIONS The number of incident and prevalent PAD cases generally showed an increasing trend. Visits to tertiary and general hospitals were higher among men than women. These results indicate the need for attention not only to Western and male patients, but also to Eastern and female patients with PAD. The results are generalizable, as they are based on national claims data from the entire South Korean population, and they can promote preventive care and management strategies for patients with PAD in clinical and public health settings.
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Affiliation(s)
- Gi Wook Ryu
- Department of Nursing, Hansei University, Gunpo-si, Republic of Korea
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young Shin Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jeewuan Kim
- Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea
| | - Yong Sook Yang
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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de Bakker M, Timmerman N, van Koeverden ID, de Kleijn DPV, de Borst GJ, Pasterkamp G, Boersma E, den Ruijter HM. The age- and sex-specific composition of atherosclerotic plaques in vascular surgery patients. Atherosclerosis 2020; 310:1-10. [PMID: 32861960 DOI: 10.1016/j.atherosclerosis.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/15/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The sex- and age-related differences in the composition of iliofemoral atherosclerotic plaques are largely unknown. Therefore, the aim of the current study is to gain insight into plaque composition across strata of age and sex in a large cohort of vascular surgery patients. METHODS Peripheral atherosclerotic plaques of patients who underwent iliofemoral endarterectomy (n = 790) were harvested between 2002 and 2014. The plaques were semi-quantitatively analyzed for the presence of lipid cores, calcifications, plaque hemorrhages (PH), collagen, macrophage and smooth muscle cell (SMC) content, and quantitatively for microvessel density. Patients were stratified by age tertiles and sex. RESULTS Ageing was independently associated with rupture-prone iliofemoral plaque characteristics, such as higher prevalence of plaque calcifications (OR 1.52 (95%CI:1.03-2.24) p = 0.035) and PH (OR 1.46 (95%CI:1.01-2.09) p = 0.042), and lower prevalence of collagen (OR 0.52 (95%CI:0.31-0.86) p = 0.012) and SMCs (OR 0.59 (95%CI:0.39-0.90) p = 0.015). Sex-stratified data showed that men had a higher prevalence of lipid cores (OR 1.62 (95%CI:1.06-2.45) p = 0.025) and PH (OR 1.62 (95%CI:1.16-2.54) p = 0.004) compared to women. These sex-differences attenuated with increasing age, with women showing an age-related increase in calcifications (p = 0.002), PH (p = 0.015) and decrease in macrophages (p = 0.005). In contrast, men only showed a decrease in collagen (p = 0.043). CONCLUSIONS Atherosclerotic iliofemoral plaques derived from men display more rupture-prone characteristics compared to women. Yet, this difference is attenuated with an increase in age, with older women having more rupture-prone characteristics compared to younger women.
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Affiliation(s)
- Marie de Bakker
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ian D van Koeverden
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Eric Boersma
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
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Yoshida H, Inaguma D, Koshi-Ito E, Ogata S, Kitagawa A, Takahashi K, Koide S, Hayashi H, Hasegawa M, Yuzawa Y, Tsuboi N. Extreme hyperuricemia is a risk factor for infection-related deaths in incident dialysis patients: a multicenter prospective cohort study. Ren Fail 2020; 42:646-655. [PMID: 32662307 PMCID: PMC7470168 DOI: 10.1080/0886022x.2020.1788582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction There are few studies on the association between serum uric acid (UA) level and mortality in incident dialysis patients. We aimed to clarify whether the serum UA level at dialysis initiation is associated with mortality during maintenance dialysis. Methods We enrolled 1486 incident dialysis patients who participated in a previous multicenter prospective cohort study in Japan. We classified the patients into the following five groups according to their serum UA levels at dialysis initiation: G1 with a serum UA level <6 mg/dL; G2, 6.0–8.0 mg/dL; G3, 8.0–10.0 mg/dL; G4, 10.0–12.0 mg/dL; and G5, ≥12.0 mg/dL. We created three models (Model 1: adjusted for age and sex, Model 2: adjusted for Model 1 + 12 variables, and Model 3: stepwise regression adjusted for Model 2 + 13 variables) and performed a multivariate Cox proportional hazard regression analysis to examine the association between the serum UA level and outcomes, including infection-related mortality. Results Hazard ratios (HRs) were calculated relative to the G2, because the all-cause mortality rate was the lowest in G2. For Models 1 and 2, the all-cause mortality rate was significantly higher in G5 than in G2 (HR: 1.63, 95% confidence interval [CI]: 1.14–2.33 and HR: 1.78, 95% CI: 1.19–2.68, respectively). For Models 1, 2, and 3, the infection-related mortality rate was significantly higher in G5 than in G2 (HR: 2.75, 95% CI: 1.37–5.54, HR: 3.09, 95% CI: 1.45–6.59, HR: 3.37, and 95% CI: 1.24–9.15, respectively). Conclusions Extreme hyperuricemia (serum UA level ≥12.0 mg/dL) at dialysis initiation is a risk factor for infection-related deaths.
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Affiliation(s)
- Hiroyuki Yoshida
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Eri Koshi-Ito
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soshiro Ogata
- Faculty of Nursing, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Preventive Medicine & Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akimitsu Kitagawa
- Department of Nephrology, Fujita Health University, Bantane Hospital, Nagoya, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
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Li CH, Li CC, Lu CL, Wu JS, Ku LJE, Li CY. Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan. BMC Public Health 2020; 20:212. [PMID: 32046698 PMCID: PMC7014711 DOI: 10.1186/s12889-020-8335-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background To assess the prevalence of urban-rural disparity in lower extremities amputation (LEA) among patients with diabetes and to explore whether patient-related or physician-related factors might have contributed to such disparity. Methods This was a population-based study including patients with diabetes aged ≥55 years from 2009 to 2013. Among them, 9236 received LEA. Data were retrieved from Taiwan’s National Health Insurance (NHI) claims. A multiple Poisson regression model was also employed to assess the urban-rural difference in LEA prevalence by simultaneously taking into account socio-demographic variables and density of practicing physicians. Results Between 2009 and 2013, the annual prevalence of LEA declined from 30.4 to 20.5 per 10,000 patients. Compared to patients from urban areas, those who lived in sub-urban and rural areas suffered from a significantly elevated prevalence of LEA, with a prevalence rate ratio (PRR) of 1.47 (95% CI, 1.39–1.55) and 1.68 (95% CI, 1.56–1.82), respectively. The density of physicians who presumably provided diabetes care can barely explain the urban-rural disparity in LEA prevalence. Conclusions Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in LEA prevalence still exists in Taiwan after nearly two decades of the NHI program.
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Affiliation(s)
- Chung-Hao Li
- Department of Health Management Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Chun Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan
| | - Chin-Li Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.,Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Jung Elizabeth Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 701, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Bauersachs R, Debus S, Nehler M, Huelsebeck M, Balradj J, Bowrin K, Briere JB. A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease. Angiology 2019; 71:303-314. [DOI: 10.1177/0003319719896477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.
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Affiliation(s)
- Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmBH, Darmstadt, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery, Angiology, Endovascular Interventions, University of Hamburg-Eppendorf, Hamburg Germany
| | - Mark Nehler
- Vascular Surgery and Endovascular Therapy Faculty, University of Colorado and CPC Research, Denver, CO, USA
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