Loss to follow-up 1 year after lower extremity peripheral vascular intervention is associated with worse survival

2019 ◽  
Vol 24 (4) ◽  
pp. 332-338 ◽  
Author(s):  
Grace J Wang ◽  
Dejah R Judelson ◽  
Philip P Goodney ◽  
Daniel J Bertges
Keyword(s):  
Lower Extremity ◽  
Cox Regression ◽  
Limb Ischemia ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Chi Squared ◽  
Peripheral Vascular Intervention

Loss to follow-up (LTF) has been associated with worse outcomes after procedures. We sought to identify differences in lower extremity peripheral vascular intervention (PVI) patients with and without LTF, and to determine if LTF impacted survival. Patients in the PVI registry of the Vascular Quality Initiative (VQI) were included ( n = 39,342), where t-test and chi-squared analysis were used to compare those with and without LTF. Multivariable logistic regression was used to identify factors associated with LTF while Cox regression analysis was applied to compare survival among those with and without LTF. The overall 1-year follow-up rate was 91.6%. LTF patients were more often male, Hispanic, of black race, and had a higher rate of diabetes, coronary artery disease, congestive heart failure, and dialysis. LTF patients had a higher prevalence of critical limb ischemia, underwent popliteal or distal intervention, and were intervened upon urgently. There was also a higher rate of postoperative complications, and a lower rate of technical success for LTF patients. After controlling for center effects, the independent variables associated with LTF included male sex, age, diabetes, dialysis dependence, ASA class 3 or greater, as well as complications requiring admission. Preoperative aspirin, preadmission home living status, prior carotid intervention, and discharge aspirin were protective against LTF. Adjusted survival analysis showed decreased survival in LTF, with those returning face-to-face surviving longer than those with phone follow-up. Efforts should be focused on understanding these differences to improve follow-up rates and help improve overall survival.

scholarly journals Transition in Frailty State Among Elderly Patients After Vascular Surgery

2020 ◽  
Vol 44 (10) ◽  
pp. 3564-3572
Author(s):  
Louise B. D. Banning ◽  
Linda Visser ◽  
Clark J. Zeebregts ◽  
Barbara L. van Leeuwen ◽  
Mostafa el Moumni ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vascular Surgery ◽  
Cox Regression ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Vascular Intervention ◽  
Cox Regression Analysis ◽  
Groningen Frailty Indicator ◽  
Frail Patients

Abstract Background Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. Methods Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Results Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133–0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154–0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. Conclusions The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.

scholarly journals Discharge Prescription Patterns for Antiplatelet Therapy Following Lower Extremity Peripheral Vascular Intervention

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Nikhil Singh ◽  
Li Ding ◽  
Gregory A. Magee ◽  
David M. Shavelle ◽  
Vikram S. Kashyap ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Antiplatelet Therapy ◽  
Single Agent ◽  
Final Analysis ◽  
Prescribing Patterns ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Therapy Regimen ◽  
Peripheral Vascular Intervention ◽  
Artery Disease

Background: Despite current guidelines suggesting a benefit for dual antiplatelet therapy (DAPT) following peripheral vascular intervention (PVI), there are limited data on antiplatelet prescribing patterns post-procedure. We attempted to determine variables associated with DAPT prescription following lower extremity PVI. Methods: Retrospective analysis of patients undergoing lower extremity PVI in the Vascular Quality Initiative (2017–2018) was performed. Participants not on anticoagulation or DAPT before the procedure were considered for the final analysis. Postdischarge antiplatelet therapy regimen rates were determined (none, aspirin only, P2Y12 inhibitor only, and DAPT). Multivariate logistic regression was performed to determine variables associated with DAPT initiation compared with those discharged on single-agent or no antiplatelet therapy. Results: A total of 16 597 procedures were included for analysis, with 49% initiated on DAPT post-PVI. Male sex (odds ratio [OR], 1.12 [95% CI, 1.05–1.20]), smoking (OR, 1.20 [95% CI, 1.09–1.32]), and coronary artery disease (OR, 1.19 [95% CI, 1.11–1.27]) were associated with an increased likelihood of post-PVI DAPT prescription. Procedures requiring multiple types of interventions (OR, 1.28 [95% CI, 1.15–1.42]), stent placement (OR, 1.16 [95% CI, 1.06–1.27]), and with complications (OR, 1.31 [95% CI, 1.14–1.52]) were also positively associated with DAPT prescription. Conclusions: In patients not already receiving anticoagulation or on DAPT at the time of lower extremity PVI, prescription of DAPT following intervention is ≈50%. Multiple factors were associated with the decision for DAPT versus single antiplatelet therapy, and further study is required to understand how this affects postintervention adverse limb and cardiovascular events.

scholarly journals Active smoking is associated with higher rates of incomplete wound healing after endovascular treatment of critical limb ischemia

2020 ◽  
Vol 25 (5) ◽  
pp. 427-435
Author(s):  
Damianos G Kokkinidis ◽  
Stefanos Giannopoulos ◽  
Moosa Haider ◽  
Timothy Jordan ◽  
Anita Sarkar ◽  
...  
Keyword(s):  
Wound Healing ◽  
Regression Analysis ◽  
Cox Regression ◽  
Smoking Status ◽  
Group Versus ◽  
Limb Ischemia ◽  
Active Smoking ◽  
Cox Regression Analysis ◽  
Smoking Group

The association between active smoking and wound healing in critical limb ischemia (CLI) is unknown. Our objective was to examine in a retrospective cohort study whether active smoking is associated with higher incomplete wound healing rates in patients with CLI undergoing endovascular interventions. Smoking status was assessed at the time of the intervention, comparing active to no active smoking, and also during follow-up visits at 6 and 9 months. Cox regression analysis was conducted to compare the incomplete wound healing rates of the two groups during follow-up. A total of 264 patients (active smokers: n = 41) were included. Active smoking was associated with higher rates of incomplete wound healing in the 6-month univariate Cox regression analysis (hazard ratio (HR) for incomplete wound healing: 4.54; 95% CI: 1.41–14.28; p = 0.012). The 6-month Kaplan–Meier (KM) estimates for incomplete wound healing were 91.1% for the active smoking group versus 66% for the non-current smoking group. Active smoking was also associated with higher rates of incomplete wound healing in the 9-month univariable (HR for incomplete wound healing: 2.32; 95% CI: 1.11–4.76; p = 0.026) and multivariable analysis (HR for incomplete wound healing: 9.09; 95% CI: 1.06–100.0; p = 0.044). The 9-month KM estimates for incomplete wound healing were 75% in the active smoking group versus 54% in the non-active smoking group. In conclusion, active smoking status at the time of intervention in patients with CLI is associated with higher rates of incomplete wound healing during both 6- and 9-month follow-up.

Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention

2017 ◽  
Vol 119 (4) ◽  
pp. 669-674 ◽  
Author(s):  
Joe X. Xie ◽  
Thomas J. Glorioso ◽  
Philip B. Dattilo ◽  
Vikas Aggarwal ◽  
P. Michael Ho ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Extremity ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Peripheral Vascular Intervention

scholarly journals Predictors of retention in care in HIV-infected patients in a large hospital cohort in Italy

2018 ◽  
Vol 146 (5) ◽  
pp. 606-611 ◽  
Author(s):  
Roberta Prinapori ◽  
Barbara Giannini ◽  
Niccolò Riccardi ◽  
Francesca Bovis ◽  
Mauro Giacomini ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Retention In Care ◽  
Large Hospital ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Increased Risk

AbstractRetention in care is a key feature of the cascade of continuum of care, playing an important role in achieving therapeutic success and being crucial for reduction of HIV transmission. The aim of this study was to evaluate the rate of retention in care in a large referral centre in the North of Italy and to identify predictors associated with failed retention. All new HIV-infected subjects were consecutive enrolled from 1 January 2008 to 31 December 2014. Demographics, immune-virological status, hepatitis co-infection and timing of initiation of combined antiretroviral therapy (cART) data were collected at baseline and at the time of last observation. Failed retention in care was defined as lack of laboratory data, clinical visits and drug dispensation for more than 6 months from the last visit. Cox regression analysis was used. Multivariate analysis of variables with P<0.05 in univariate analysis was performed. We enrolled 269 patients (mean age 46.1 years). Males were 197 (73%), Italian 219 (81%) with mean length of disease of 5.1 years. cART was prescribed for 257 patients (95%). The rate of retention in care was 78.4% and the rate of virological suppression was 75%. Predictors of being loss to follow-up were foreign origin (P = 0.048), CD4+ count <200/mmc (P = 0.001) and not being treated for HIV infection (P = 0.0004). Predictors of cART efficacy were shorter duration of HIV infection and baseline HIV-RNA <100 000 copies/ml. These findings underline the necessity to improve retention in care by identifying groups at increased risk of being loss to follow-up. Retention in care of vulnerable population is crucial to reach 90-90-90 UNAIDS endpoint.

scholarly journals Determinants of Amputation-Free Survival After Peripheral Vascular Intervention for Critical Limb Ischemia

2013 ◽  
Vol 58 (3) ◽  
pp. 855
Author(s):  
Luke Vierthaler ◽  
Philip P. Goodney ◽  
Andres Schanzer ◽  
Virenda I. Patel ◽  
Jack L. Cronenwett ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Free Survival ◽  
Peripheral Vascular Intervention
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