Evaluation of Risk Factors for Limb-Specific Peripheral Vascular Events in Patients With Peripheral Artery Disease: A Post Hoc Analysis of the SEASON Prospective Observational Study

Angiology ◽  
2018 ◽  
Vol 70 (6) ◽  
pp. 506-514 ◽  
Author(s):  
Tetsuro Miyata ◽  
Yukihito Higashi ◽  
Hiroshi Shigematsu ◽  
Hideki Origasa ◽  
Masatoshi Fujita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Peripheral Artery Disease ◽  
Prospective Observational Study ◽  
Peripheral Vascular ◽  
Peripheral Artery ◽  
Vascular Events ◽  
Post Hoc Analysis ◽  
Artery Disease ◽  
Post Hoc

Abstract 16512: Amputation in Patients With Pad With and Without Diabetes: Insights From the EUCLID Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas Govsyeyev ◽  
Mark R Nehler ◽  
Cecilia C Low Wang ◽  
Sarah Kavanagh ◽  
William R Hiatt ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Artery Disease ◽  
Safety Data ◽  
Peripheral Artery ◽  
Major Morbidity ◽  
Post Hoc Analysis ◽  
Primary Driver ◽  
Artery Disease ◽  
Post Hoc ◽  
Developing Strategies

Background/Introduction: Amputation is a major morbidity of peripheral artery disease (PAD). Although traditionally attributed to ischemia, the multifactorial nature is increasingly recognized, particularly in those with concomitant diabetes mellitus (DM). Elucidating the drivers of amputation in PAD with and without DM may be important in developing strategies for prevention. Purpose: To elucidate the primary drivers of amputations in patients with PAD with and without DM. Methods: EUCLID randomized 13,885 patients with PAD. Investigators prospectively reported all amputations. In this post-hoc analysis, amputations (major – ankle and above, minor – distal to ankle) were retrospectively adjudicated using safety data when available to characterize the drivers including infection, ischemia, or multifactorial. Etiologies were evaluated by DM status at baseline. Results: A total of 415 patients (3% of total) underwent 533 (260 major and 263 minor) amputations over a median of 30 months. Of these, 360 (68%) occurred in the 5,345 patients with DM (n/N of 6.7%) and 173 (32%) occurred in the 8,450 patients without DM (n/N of 2.0%). There were 172 non-traumatic amputations with sufficient documentation to determine drivers. Ischemia was the primary driver overall (51%) followed by infection (27%) and multifactorial (22%). The primary driver, however, varied by DM status with the dominant driver in those with DM being infection (59%) and in those without DM, ischemia (82%) ( Fig. 1 ). The etiology varied for major and minor with the former driven by ischemia (65%) and the latter driven by infection (59%). Conclusions: Amputations in PAD appear to have different primary drivers depending on concomitant DM. Infection may have a larger role in those with DM and ischemia in those without DM. Further research to elucidate the pathobiology and predictors of these outcomes may help in the development of strategies for prevention.

Abstract 13342: Patient Demographics, Clinical Characteristics, Medication Utilization, Medical Resource Use and Outcomes Associated with Patients with Symptomatic Peripheral Artery Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Monica Reed Chase ◽  
Prakash Navaratnam ◽  
Howard Friedman ◽  
Kim Heithoff ◽  
Ross J Simpson
Keyword(s):  
Peripheral Artery Disease ◽  
Clinical Characteristics ◽  
Limb Amputation ◽  
Bleeding Complications ◽  
Medical Resource ◽  
Peripheral Artery ◽  
Vascular Events ◽  
Patient Demographics ◽  
Medication Utilization ◽  
Artery Disease

Background: Symptomatic peripheral artery disease (SPAD) [defined as intermittent claudication (IC) and/or critical limb ischemia requiring peripheral revascularization (PRV)] is associated with significant CV and PAD-related morbidity and mortality. However, the real world impact of SPAD has not been well characterized to date. Methods: An algorithm that selectively identifies SPAD patients using a combination of PAD related ICD-9 diagnostic and DRG codes, PRV CPT-4 procedure codes, and IC medication NDC codes was used to select study eligible patients from the MarketScan Commercial and Encounters database from 01/01/06 to 06/30/10. The earliest date of a record of SPAD was the index date and a period of 1 year pre- and 3 years post-index was the study time frame. Patients with stroke/TIA, with bleeding complications and contraindications to anti-platelet therapy were excluded. Descriptive statistics comparing patient demographics, clinical characteristics, medication utilization, medical resource utilization and outcomes (event risk estimates for MI, any stroke, revascularization (coronary and peripheral), limb amputation, acute ischemic event hospitalizations and costs) were generated. Results: A total of 16,663 patients (58.0% male; mean age (± SD) 67.2 ± 12.9 years) were identified with SPAD. SPAD patients had significant comorbidities with 31.5% CAD, 36.0% diabetes, 31.0% hyperlipidemia and 53.1% hypertension. Twenty percent (20%) of SPAD patients were on clopidogrel in the pre-index. Pre-index use of beta-blocker, ACE, ARB and statin use was 42.1%, 37.1%, 21.1% and 48.5% respectively. SPAD patients experienced CV events such as any stroke (8.9%), NSTEMI (4.1%), STEMI (4.8%) and UA (7.5%) in the post-index. SPAD patients also experienced a limb amputation (11.5%), endovascular PRV (17%), and open PRV (14.6%) in the post-index. Annualized SPAD-related hospitalization rates, inpatient costs and outpatients costs were significantly higher in the post-index (0.1 vs 0.01, $2,073 vs $175, $1,313 vs $936; all p<0.0001). Conclusion: In an insured population, SPAD patients have low utilization of preventive medications, high rates of major vascular events (both CV and PAD related) and high costs.

scholarly journals Prevalence and risk factors of peripheral artery disease in black Africans with HIV infection: a cross-sectional hospital-based study

2018 ◽  
Vol Volume 14 ◽  
pp. 401-408 ◽  
Author(s):  
Félicité Kamdem ◽  
Yacouba Mapoure ◽  
Ba Hamadou ◽  
Fanny Souksouna ◽  
Marie Solange Doualla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Cross Sectional ◽  
Black Africans ◽  
Artery Disease

Are primary care physicians aware of peripheral artery disease risk reduction and management in the Saudi healthcare transformation era? A health cluster observational study

Vascular ◽  
2021 ◽  
pp. 170853812110443
Author(s):  
Sultan Alsheikh ◽  
Hesham AlGhofili ◽  
Omar A Alayed ◽  
Abdulkareem Aldrak ◽  
Kaisor Iqbal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Saudi Arabia ◽  
Risk Reduction ◽  
Peripheral Artery Disease ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Peripheral Artery ◽  
Artery Disease

Introduction Patients with peripheral artery disease (PAD) are often underdiagnosed and undertreated. This study aimed to assess the knowledge of the recommended target levels of blood pressure, low-density lipoprotein cholesterol, glycosylated hemoglobin A1C, and knowledge and attitude about PAD risk reduction therapies among physicians working in primary care settings in Saudi Arabia. Methods This observational cross-sectional study included family medicine consultants, residents, and general practitioners working in a health cluster in the capital city of Saudi Arabia using a self-administered questionnaire. Results Of the 129 physicians who completed the survey, 55% had completed PAD-related continuing medical education hours within the past 2 years. Despite this, the knowledge score of the recommended target levels was high in only 13.2% of the participants. Antiplatelet therapy was prescribed by 68.2% of the participants. Conclusion Here we identified the knowledge and action gaps among primary care providers in Saudi Arabia. Physicians had an excellent attitude about screening for and counseling about risk factors. However, they showed less interference in reducing these risk factors. We recommend addressing these knowledge gaps early in medical school and residency programs.

Abstract 91: Are At Risk Outpatient Cardiology Patients being Appropriately Evaluated for Lower Extremity PAD as Recommended by ACC/AHA Guidelines?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Rajesh M Kabadi ◽  
Ankitkumar Patel ◽  
Rajani Sharma ◽  
Rita Schmidt ◽  
Elias Iliadis
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
High Risk ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Heart Association ◽  
Low Risk ◽  
Peripheral Artery ◽  
Artery Disease

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. Once appropriate at risk patients are identified, ankle-brachial index (ABI) testing is a relatively quick and inexpensive test that is recommended for proper assessment of PAD, per the recommendations outlined in the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006). Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to test and appropriately treat this condition. Methods: A randomly selected group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent retrospective chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors were classified as high risk and those with less than that were classified as low risk and frequency of ABI testing was evaluated. Fishers exact test was utilized for statistical analysis. Results: Fifty-one percent (N=187) of our population were classified as high risk for PAD, forty-three percent (N=158) were low risk, and six percent (N=22) were known to already have PAD. Amongst the high risk individuals, only six percent (N=12) had ABI testing performed while there were three percent (N=6) of low risk individuals that had this test (p=-0.34). Conclusions: There was no difference in ABI testing between high and low risk populations. Limitations of this study include lack of information regarding other diagnostic modalities that may have been used in place of ABI testing. Quality improvement may be achieved by increased use of such testing as this would allow for quicker identification of the disease, prompter treatment, and better outcomes, at a minimal cost.

scholarly journals Clinical Outcome and Diverse Risk Factors for Different Therapeutic Target Locations of Peripheral Artery Disease

2020 ◽  
Vol 27 (8) ◽  
pp. 769-779 ◽  
Author(s):  
Toshiyuki Ko ◽  
Michiaki Higashitani ◽  
Yukari Uemura ◽  
Makoto Utsunomiya ◽  
Tetsuo Yamaguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Peripheral Artery Disease ◽  
Therapeutic Target ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Target Locations
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