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Keekstra N, Biemond M, van Schaik J, Schepers A, Hamming JF, van der Vorst JR, Lindeman JHN. Toward Uniform Case Identification Criteria in Observational Studies on Peripheral Arterial Disease: A Scoping Review. Ann Vasc Surg 2024; 106:71-79. [PMID: 38615752 DOI: 10.1016/j.avsg.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The diagnosis of peripheral arterial disease (PAD) is commonly applied for symptoms related to atherosclerotic obstructions in the lower extremity, though its clinical manifestations range from an abnormal ankle-brachial index to critical limb ischemia. Subsequently, management and prognosis of PAD vary widely with the disease stage. A critical aspect is how this variation is addressed in administrative database-based studies that rely on diagnosis codes for case identification. The objective of this scoping review is to inventory the identification strategies used in studies on PAD that rely on administrative databases, to map the pros and cons of the International Classification of Diseases (ICD) codes applied, and to propose a first outline for a consensus framework for case identification in administrative databases. METHODS Registry-based reports published between 2010 and 2021 were identified through a systematic PubMed search. Studies were subcategorized on the basis of the expressed study focus: claudication, critical limb ischemia, or general peripheral arterial disease, and the ICD code(s) applied for case identification mapped. RESULTS Ninety studies were identified, of which 36 (40%) did not specify the grade of PAD studied. Forty-nine (54%) articles specified PAD grade studied. Five (6%) articles specified different PAD subgroups in methods and baseline demographics, but not in further analyses. Mapping of the ICD codes applied for case identification for studies that specified the PAD grade studied indicated a remarkable heterogeneity, overlap, and inconsistency. CONCLUSIONS A large proportion of registry-based studies on PAD fail to define the study focus. In addition, inconsistent strategies are used for PAD case identification in studies that report a focus. These findings challenge study validity and interfere with inter-study comparison. This scoping review provides a first initiative for a consensus framework for standardized case selection in administrative studies on PAD. It is anticipated that more uniform coding will improve study validity and facilitate inter-study comparisons.
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Affiliation(s)
- Niels Keekstra
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mathijs Biemond
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Jan H N Lindeman
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
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Szeto K, Arnold J, Horsfall EM, Sarro M, Hewitt A, Maher C. Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study. JMIR Mhealth Uhealth 2024; 12:e55254. [PMID: 39178034 PMCID: PMC11380062 DOI: 10.2196/55254] [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: 12/06/2023] [Revised: 05/01/2024] [Accepted: 06/18/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings. OBJECTIVE This study aimed to develop a consensus-based framework for the optimal use of WATs in health care. METHODS A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants' opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist's clarity, utility, and appropriateness. RESULTS Participation rates for rounds 1 to 4 were 76% (n=44), 74% (n=43), 74% (n=43), and 66% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients' data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4. CONCLUSIONS This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector.
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Affiliation(s)
- Kimberley Szeto
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Perfomance, University of South Australia, Adelaide, Australia
| | - John Arnold
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Perfomance, University of South Australia, Adelaide, Australia
| | - Erin Marie Horsfall
- Allied Health and Human Perfomance, University of South Australia, Adelaide, Australia
| | - Madeline Sarro
- Allied Health and Human Perfomance, University of South Australia, Adelaide, Australia
| | - Anthony Hewitt
- Southern Adelaide Local Health Network, South Australia Health, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Perfomance, University of South Australia, Adelaide, Australia
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Szeto K, Arnold J, Maher C. The Wearable Activity Tracker Checklist for Healthcare (WATCH): a 12-point guide for the implementation of wearable activity trackers in healthcare. Int J Behav Nutr Phys Act 2024; 21:30. [PMID: 38481238 PMCID: PMC10938760 DOI: 10.1186/s12966-024-01567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/27/2024] [Indexed: 03/17/2024] Open
Abstract
Increasing physical activity in patients offers dual benefits, fostering improved patient health and recovery, while also bolstering healthcare system efficiency by minimizing costs related to extended hospital stays, complications, and readmissions. Wearable activity trackers offer valuable opportunities to enhance physical activity across various healthcare settings and among different patient groups. However, their integration into healthcare faces multiple implementation challenges related to the devices themselves, patients, clinicians, and systemic factors. This article presents the Wearable Activity Tracker Checklist for Healthcare (WATCH), which was recently developed through an international Delphi study. The WATCH provides a comprehensive framework for implementation and evaluation of wearable activity trackers in healthcare. It covers the purpose and setting for usage; patient, provider, and support personnel roles; selection of relevant metrics; device specifications; procedural steps for issuance and maintenance; data management; timelines; necessary adaptations for specific scenarios; and essential resources (such as education and training) for effective implementation. The WATCH is designed to support the implementation of wearable activity trackers across a wide range of healthcare populations and settings, and in those with varied levels of experience. The overarching goal is to support broader, sustained, and systematic use of wearable activity trackers in healthcare, therefore fostering enhanced physical activity promotion and improved patient outcomes.
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Affiliation(s)
- Kimberley Szeto
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia
| | - John Arnold
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia
| | - Carol Maher
- Alliance for Research in Exercise Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, North Terrace, GPO Box 2471, 5001, Adelaide, SA, Australia.
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Adzrago D, Sulley S, Ormiston CK, Williams F. Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic. Prev Med Rep 2024; 37:102555. [PMID: 38170022 PMCID: PMC10758958 DOI: 10.1016/j.pmedr.2023.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals' ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18-64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/poor health (OR = 0.24, 95% CI = 0.27, 0.63), obesity (OR = 0.51, 95% CI = 0.33, 0.79), anxiety/depression (OR = 0.60, 95% CI = 0.42, 0.85), or a cancer diagnosis (OR = 0.56, 95% CI = 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR = 0.44, 95% CI = 0.28, 0.70), anxiety/depression (OR = 0.61, 95% CI = 0.43, 0.86), less than high school education (OR = 0.33, 95% CI = 0.16, 0.70), or family income of $20,000 - $34,999 (OR = 0.42, 95% CI = 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.
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Affiliation(s)
- David Adzrago
- Division of Intramural Research, National Institute on Minority Health and Health Disparities,National Institutes of Health, Bethesda, MD, USA
| | - Saanie Sulley
- National Healthy Start Association, Washington, DC, USA
| | - Cameron K. Ormiston
- Division of Intramural Research, National Institute on Minority Health and Health Disparities,National Institutes of Health, Bethesda, MD, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities,National Institutes of Health, Bethesda, MD, USA
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Enea I, Martelli E. Focus on the Prevention of Acute Limb Ischemia: Centrality of the General Practitioner from the Point of View of the Internist. J Clin Med 2023; 12:3652. [PMID: 37297848 PMCID: PMC10254060 DOI: 10.3390/jcm12113652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
The thrombotic mechanism, being common to peripheral arterial disease (PAD), acute myocardial infarction (AMI), and stroke, is responsible for the highest number of deaths in the western world. However, while much has been done for the prevention, early diagnosis, therapy of AMI and stroke, the same cannot be said for PAD, which is a negative prognostic indicator for cardiovascular death. Acute limb ischemia (ALI) and chronic limb ischemia (CLI) are the most severe manifestations of PAD. They both are defined by the presence of PAD, rest pain, gangrene, or ulceration and we consider ALI if symptoms last less than 2 weeks and CLI if they last more than 2 weeks. The most frequent causes are certainly atherosclerotic and embolic mechanisms and, to a lesser extent, traumatic or surgical mechanisms. From a pathophysiological point of view, atherosclerotic, thromboembolic, inflammatory mechanisms are implicated. ALI is a medical emergency that puts both limb and the patient's life at risk. In patients over age 80 undergoing surgery, mortality remains high reaching approximately 40% as well as amputation approximately 11%. The purpose of this paper is to summarize the scientific evidence on the possibilities of primary and secondary prevention of ALI and to raise awareness among doctors involved in the management of ALI, in particular by describing the central role of the general practitioner.
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Affiliation(s)
- Iolanda Enea
- Emergency Department, S. Anna and S. Sebastiano Hospital, 81100 Caserta, Italy
| | - Eugenio Martelli
- Division of Vascular Surgery, Department of Cardiovascular Science, S. Anna and S. Sebastiano Hospital, Campania, 81100 Caserta, Italy;
- Department of General and Specialist Surgery Paride Stefanini, Faculty of Pharmacy and Medicine, Sapienza University of Rome, 00161 Rome, Italy
- Medicine and Surgery School of Medicine, Saint Camillus International University of Health Science, 00131 Rome, Italy
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Bruinius JW, Hannan M, Chen J, Brown J, Kansal M, Meza N, Saunders MR, He J, Ricardo AC, Lash JP. Self-reported Physical Activity and Cardiovascular Events in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) Study. Am J Kidney Dis 2022; 80:751-761.e1. [PMID: 35810825 PMCID: PMC9691530 DOI: 10.1053/j.ajkd.2022.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/04/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE In the general population, there is an association between higher levels of physical activity and lower risk for cardiovascular events and mortality, but this relationship has not been well evaluated in chronic kidney disease (CKD). We investigated the association between self-reported physical activity and outcomes in a CKD cohort. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 3,926 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Time-updated self-reported physical activity assessed by (1) quartile of moderate-to-vigorous physical activity (MVPA) and (2) meeting guideline-recommended level of physical activity (categorized as active, meeting guidelines; active, not meeting guidelines; or inactive). OUTCOME Atherosclerotic events (myocardial infarction, stroke, or peripheral artery disease), incident heart failure, and all-cause and cardiovascular death. ANALYTICAL APPROACH Cox proportional hazards regression. RESULTS At baseline, compared with the lowest MVPA quartile, those in the highest quartile were more likely to be younger, male, not have prevalent cardiovascular disease, and have higher estimated glomerular filtration rate. Overall, 51% met the physical activity guidelines; of those who did not, 30% were inactive. During the median follow-up period of 13.4 years, there were 772 atherosclerotic events, 848 heart failure events, and 1,553 deaths, and 420 cardiovascular deaths. Compared with the participants in the lowest MVPA quartile, the highest quartile had a lower risk of atherosclerotic events (HR, 0.64 [95% CI, 0.51-0.79]), incident heart failure (HR, 0.71 [95% CI, 0.58-0.87]), and all-cause and cardiovascular death (HRs of 0.54 [95% CI, 0.46-0.63] and 0.47 [95% CI, 0.35-0.64], respectively). The findings were similar for analyses evaluating recommended level of physical activity. LIMITATIONS Self-reported physical activity may result in some degree of misclassification. CONCLUSIONS Higher self-reported physical activity was associated with lower risk of cardiovascular events and mortality in CKD patients, which may have important implications for clinical practice and the design of interventional studies. PLAIN-LANGUAGE SUMMARY In this long-term study of 3,926 adults with chronic kidney disease, we found that individuals with higher levels of physical activity were less likely to experience an atherosclerotic event (for example, a heart attack, stroke, or peripheral arterial disease), new-onset heart failure, and death as compared with those with lower levels of physical activity. The findings were similar for the analyses evaluating adherence to guideline-recommended level of physical activity (that is, for more than 150 minutes per week), and they strengthen the evidence supporting the current guideline recommendations.
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Affiliation(s)
- Jacob W Bruinius
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mary Hannan
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jinsong Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Julia Brown
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mayank Kansal
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Natalie Meza
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Milda R Saunders
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
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Mallamaci F, D’Arrigo G, Tripepi G, Lamberti N, Torino C, Manfredini F, Zoccali C. Long-Term Effect of Physical Exercise on the Risk for Hospitalization and Death in Dialysis Patients: A Post-Trial Long-Term Observational Study. Clin J Am Soc Nephrol 2022; 17:1176-1182. [PMID: 35878932 PMCID: PMC9435990 DOI: 10.2215/cjn.03160322] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In total, 227 patients (exercise, n=104; control, n=123) completed the 6-month trial and entered the post-trial observational study. Data were analyzed by unadjusted and adjusted Cox regression analyses and Bayesian analysis. RESULTS In the long-term observation (up to 36 months), 134 events were recorded (eight deaths not preceded by hospitalization and 126 hospitalizations, which were followed by death in 38 cases). The long-term risk for hospitalization or death was 29% lower (hazard ratio, 0.71; 95% confidence interval, 0.50 to 1.00), and in an analysis stratified by adherence to the walking exercise program during the 6-month trial, the subgroup with high adherence (>60% of prescribed sessions) had a 45% lower risk as compared with the control group (hazard ratio, 0.55; 95% confidence interval, 0.35 to 0.87). A Bayesian analysis showed that the posterior probability of a hazard ratio of 0.71 (95% confidence interval, 0.50 to 1.00) for the risk of the composite outcome observed in the post-trial observational study was 93% under the conservative prior and 97% under the optimistic prior. Sensitivity analyses restricted to the risk of hospitalization only or censoring patients at the time of transplantation fully confirmed these findings. CONCLUSIONS A simple, personalized, home-based, low-intensity exercise program was associated with a lower risk of hospitalization. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER EXerCise Introduction to Enhance Performance in Dialysis (EXCITE), NCT01255969.
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Affiliation(s)
- Francesca Mallamaci
- Clinical Epidemiology of Renal Diseases and Hypertension Unit, Institute of Clinical Physiology, Reggio Calabria, Italy,Nephrology, Dialysis and Renal Transplantation Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Graziella D’Arrigo
- Clinical Epidemiology of Renal Diseases and Hypertension Unit, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology of Renal Diseases and Hypertension Unit, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
| | - Claudia Torino
- Clinical Epidemiology of Renal Diseases and Hypertension Unit, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Section of Sport Sciences, University of Ferrara, Ferrara, Italy
| | - Carmine Zoccali
- Renal Research Institute, New York, New York,Associazione Ipertensione Nefrologia e Trapianto Renale c/o Nefrologia, Ospedali Riuniti, Reggio Calabria, Italy
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Rodighiero J, Léveillé N, Shen S, Ekmekjian T, Ades M, Drudi LM. A scoping review of malnutrition in patients undergoing interventions for peripheral arterial disease. J Vasc Surg 2022; 76:1742-1754.e3. [PMID: 35709852 DOI: 10.1016/j.jvs.2022.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is associated with comorbid conditions and frailty. The role of pre-operative nutrition in these patients with PAD is not well characterized. This scoping review sought to describe the prevalence and prognostic implications of pre-operative malnutrition in patients undergoing vascular interventions for claudication or critical limb threatening ischemia (CLTI). METHODS Studies were systematically searched across 6 databases from inception to August 2021. Studies focusing on patients with claudication or CLTI undergoing open or endovascular procedures were included if pre-operative nutrition was measured and correlated with a clinical outcome. RESULTS Of 4186 records identified, 24 studies addressed the prevalence or prognostic impact of malnutrition in patients undergoing interventions for PAD. The proportion of women included in these studies ranged from 6% to 58%. The prevalence of pre-operative malnutrition ranged from 14.6% to 72%, and notably 7 different malnutrition assessments were used in these studies. Across all scales, pre-operative malnutrition was associated with at least one of the following outcomes: mortality, post-operative complications, length of stay, readmission rates, as well as delayed wound healing. CONCLUSION There are a variety of tools used to measure malnutrition in patients undergoing interventions for PAD. Our findings suggest that pre-operative malnutrition is associated with adverse clinical outcomes in patients undergoing open and endovascular procedures for claudication or CLTI, and there is lack of consensus on which tool to use. Clinicians and surgeons should be sensitized to the importance of assessing malnutrition preoperatively in adults undergoing interventions for PAD.
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Affiliation(s)
| | - Nayla Léveillé
- Faculté de médecine de l'Université de Montréal, Montreal, QC, Canada
| | - Shiyang Shen
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Library, McGill University Health Centre, Montreal, QC, Canada
| | - Matthew Ades
- Department of Medicine, Division of General Internal Medicine, McGill Univeristy, Montreal, QC, Canada
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de L'Université de Montréal (CRCHUM), Montreal, QC, Canada.
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Liang YS, Yeh KC, Pan SL. Osteoporosis and the long-term risk of peripheral artery disease: a population-based longitudinal follow-up study in Taiwan. Osteoporos Int 2022; 33:1117-1123. [PMID: 35018479 DOI: 10.1007/s00198-022-06305-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Osteoporosis has been linked to atherosclerotic diseases such as coronary heart disease and ischemic stroke. However, the relationship between osteoporosis and peripheral artery disease (PAD) has not been investigated. This study aims to evaluate the risk of PAD in patients with osteoporosis and the impact of sex on this association. METHODS This population-based study used the Longitudinal Health Insurance Database 2005, a subset of Taiwan's National Health Insurance research database. A total of 54,324 individuals between 40 and 79 years old were included in this study. The osteoporosis group (n = 27,162) consisted of patients with a diagnosis of osteoporosis between January 1, 2002, and December 31, 2006, while the non-osteoporosis group were patients without osteoporosis selected by stratified random sampling (n = 27,162). The primary outcome was the occurrence of newly diagnosed PAD. Cox proportional hazard regression modeling was used to evaluate the association between osteoporosis and the risk of PAD, with adjustment for the baseline characteristics. RESULTS The risk of PAD for the osteoporosis group was 28% higher than for the non-osteoporosis group (adjusted hazard ratio (HR) 1.28, 95% confidence interval [CI] 1.20-1.36, p < 0.001), and the PAD-free survival rate was lower in the osteoporosis group (p < 0.001). Sex-stratified analysis revealed a similar HR magnitude between osteoporotic men (HR 1.36; 95% CI 1.19-1.57) and women (HR 1.25; 95% CI 1.17-1.35), compared with their non-osteoporotic counterparts. CONCLUSION This study found an increased long-term risk of PAD in both men and women with osteoporosis. Osteoporosis has been associated with increased risks of atherosclerotic diseases. However, the relationship between osteoporosis and peripheral artery disease remains uncertain. The present population-based longitudinal follow-up study showed that patients with osteoporosis are at an increased risk of developing peripheral artery disease.
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Affiliation(s)
- Yu-Shiuan Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Cheng Yeh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Kou M, Ding N, Ballew SH, Salameh MJ, Martin SS, Selvin E, Heiss G, Ballantyne CM, Matsushita K, Hoogeveen RC. Conventional and Novel Lipid Measures and Risk of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2021; 41:1229-1238. [PMID: 33504178 PMCID: PMC8188625 DOI: 10.1161/atvbaha.120.315828] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to comprehensively assess the association of multiple lipid measures with incident peripheral artery disease (PAD). Approach and Results: We used Cox proportional hazards models to characterize the associations of each of the fasting lipid measures (total cholesterol, LDL-C [low-density lipoprotein cholesterol], HDL-C [high-density lipoprotein cholesterol], triglycerides, RLP-C [remnant lipoprotein cholesterol], LDL-TG [LDL-triglycerides], sdLDL-C [small dense LDL-C], and Apo-E-HDL [Apo-E-containing HDL-C]) with incident PAD identified by pertinent International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge codes (eg, 440.2) among 8330 Black and White ARIC (Atherosclerosis Risk in Communities) participants (mean age 62.8 [SD 5.6] years) free of PAD at baseline (1996-1998) through 2015. Since lipid traits are biologically correlated to each other, we also conducted principal component analysis to identify underlying components for PAD risk. There were 246 incident PAD cases with a median follow-up of 17 years. After accounting for potential confounders, the following lipid measures were significantly associated with PAD (hazard ratio per 1-SD increment [decrement for HDL-C and Apo-E-HDL]): triglycerides, 1.21 (95% CI, 1.08-1.36); RLP-C, 1.18 (1.08-1.29); LDL-TG, 1.18 (1.05-1.33); HDL-C, 1.39 (1.16-1.67); and Apo-E-HDL, 1.27 (1.07-1.51). The principal component analysis identified 3 components (1: mainly loaded by triglycerides, RLP-C, LDL-TG, and sdLDL-C; 2: by HDL-C and Apo-E-HDL; and 3: by LDL-C and RLP-C). Components 1 and 2 showed independent associations with incident PAD. CONCLUSIONS Triglyceride-related and HDL-related lipids were independently associated with incident PAD, which has implications on preventive strategies for PAD. However, none of the novel lipid measures outperformed conventional ones. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Minghao Kou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ning Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maya J. Salameh
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Seth S. Martin
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
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Lu Y, Ballew SH, Kwak L, Selvin E, Kalbaugh CA, Schrack JA, Matsushita K, Szklo M. Physical Activity and Subsequent Risk of Hospitalization With Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study. J Am Heart Assoc 2019; 8:e013534. [PMID: 31642360 PMCID: PMC6898846 DOI: 10.1161/jaha.119.013534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
Background Whether physical activity is a determinant of peripheral artery disease (PAD) remains unclear. We therefore assessed the association of physical activity (amount and intensity) with subsequent risk of hospitalization with PAD and its severe form, critical limb ischemia, in the ARIC (Atherosclerosis Risk in Communities) study. Methods and Results We included 12 513 participants free of cardiovascular disease at baseline (1987-1989), with a mean age of 53.9 years, 55.3% women, and 25.0% black. Physical activity was assessed using a modified Baecke questionnaire and categorized into poor (no moderate [3 to <6 metabolic equivalents] or vigorous [≥6 metabolic equivalents] exercise), intermediate (1-74 min/wk vigorous or 1-149 min/wk moderate plus vigorous exercise), and recommended (≥75 min/wk vigorous or ≥150 min/wk moderate plus vigorous exercise). We also modeled moderate and vigorous exercise individually. All analyses applied Cox regression models. Intermediate and recommended exercise were seen in 24.7% and 38.1%, respectively. During a median follow-up of 25.4 years, 434 incident hospitalizations with PAD (166 critical limb ischemia) were documented. Recommended versus poor activity was associated with a lower demographically adjusted PAD risk (hazard ratio, 0.68; 95% CI, 0.54-0.85) but attenuated after accounting for lifestyle factors (hazard ratio, 0.84; 95% CI, 0.66-1.05). When analyzing moderate and vigorous exercise separately, vigorous exercise was robustly related to lower risk of hospitalization with PAD, and critical limb ischemia in particular (hazard ratio, 0.72; 95% CI, 0.54-0.97 per 200 metabolic equivalents*min/wk increment in the most extended model). Conclusions Higher amount and intensity of physical activity were related to lower risks of hospitalization with PAD and critical limb ischemia, further highlighting the importance of engaging in physical activity for vascular health.
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Affiliation(s)
- Yifei Lu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Shoshana H. Ballew
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lucia Kwak
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Moyses Szklo
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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