TY - JOUR
T1 - Trends in Hospitalization, Management, and Clinical Outcomes among Veterans with Critical Limb Ischemia
AU - Mentias, Amgad
AU - Qazi, Abdul
AU - McCoy, Kimberly
AU - Wallace, Robert
AU - Vaughan-Sarrazin, Mary
AU - Girotra, Saket
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background: Contemporary patterns in management and outcomes of critical limb ischemia among United States veterans are unknown. Methods: We used Veterans Health Administration data to identify patients admitted for critical limb ischemia between 2005 and 2014. We examined temporal trends in incidence, management, and outcomes. Results: A total of 20 938 veterans with critical limb ischemia were hospitalized between 2005 and 2014. Mean age was 67.8 years. Incidence decreased from 0.3 to 0.24 per 1000 persons from 2005 to 2013, P<0.01. During the study period, there was a temporal increase in use of revascularization within 90 days of hospitalization - endovascular (11.2% in 2005 to 18.4% in 2014), surgical (23.8% in 2005 to 26.4% in 2014), and hybrid (6.2% in 2005 to 13.1% in 2014, P value for trend <0.01). Statin prescriptions increased from 47.4% in 2005 to 60.9% in 2014 (P value for trend <0.01). There was a significant decline in risk-adjusted mortality (11.8% in 2005 to 9.7% in 2014) and major amputation (19.8% in 2005 to 12.9% in 2014; P value for trend <0.01 for both) at 90 days. In adjusted analyses, revascularization was associated with a lower risk of mortality (RR, 0.45 [95% CI, 0.41-0.50]; P<0.001) and major amputation at 90 days (RR, 0.23 [95% CI, 0.21-0.26]; P<0.001). Nearly half of the patients who underwent amputation did not receive an invasive vascular procedure within the preceding 90 days. There was large site-level variation in the use of revascularization (median rate, 41.7% [interquartile range, 12.5%-53.2%]). Differences in patient case-mix explained only 8% of site-level variation in receipt of revascularization. Conclusions: Over the past decade, use of revascularization increased among veterans with critical limb ischemia, which was accompanied by a reduction in mortality and major amputation. However, opportunities to further improve care in this high-risk population still remain.
AB - Background: Contemporary patterns in management and outcomes of critical limb ischemia among United States veterans are unknown. Methods: We used Veterans Health Administration data to identify patients admitted for critical limb ischemia between 2005 and 2014. We examined temporal trends in incidence, management, and outcomes. Results: A total of 20 938 veterans with critical limb ischemia were hospitalized between 2005 and 2014. Mean age was 67.8 years. Incidence decreased from 0.3 to 0.24 per 1000 persons from 2005 to 2013, P<0.01. During the study period, there was a temporal increase in use of revascularization within 90 days of hospitalization - endovascular (11.2% in 2005 to 18.4% in 2014), surgical (23.8% in 2005 to 26.4% in 2014), and hybrid (6.2% in 2005 to 13.1% in 2014, P value for trend <0.01). Statin prescriptions increased from 47.4% in 2005 to 60.9% in 2014 (P value for trend <0.01). There was a significant decline in risk-adjusted mortality (11.8% in 2005 to 9.7% in 2014) and major amputation (19.8% in 2005 to 12.9% in 2014; P value for trend <0.01 for both) at 90 days. In adjusted analyses, revascularization was associated with a lower risk of mortality (RR, 0.45 [95% CI, 0.41-0.50]; P<0.001) and major amputation at 90 days (RR, 0.23 [95% CI, 0.21-0.26]; P<0.001). Nearly half of the patients who underwent amputation did not receive an invasive vascular procedure within the preceding 90 days. There was large site-level variation in the use of revascularization (median rate, 41.7% [interquartile range, 12.5%-53.2%]). Differences in patient case-mix explained only 8% of site-level variation in receipt of revascularization. Conclusions: Over the past decade, use of revascularization increased among veterans with critical limb ischemia, which was accompanied by a reduction in mortality and major amputation. However, opportunities to further improve care in this high-risk population still remain.
KW - amputation
KW - hospitalization
KW - incidence
KW - peripheral arterial disease
KW - prescriptions
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U2 - 10.1161/CIRCINTERVENTIONS.119.008597
DO - 10.1161/CIRCINTERVENTIONS.119.008597
M3 - Article
C2 - 32069107
AN - SCOPUS:85079605806
SN - 1941-7640
VL - 13
SP - E008597
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 2
ER -