scholarly journals Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

2021 ◽  
Vol 8 ◽  
Author(s):  
LaiTe Chen ◽  
Donglan Zhang ◽  
Lu Shi ◽  
Corey A. Kalbaugh
Keyword(s):  
Native American ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Peripheral Artery Disease ◽  
Pacific Islander ◽  
Pacific Islanders ◽  
Peripheral Artery ◽  
Race Ethnicity ◽  
Artery Disease ◽  
Racial Ethnic

Background: To assess racial/ethnic differences in disease severity, hospital outcomes, length of stay and healthcare costs among hospitalized patients with peripheral artery disease (PAD).Methods: This study used data from the National Inpatient Sample (NIS) to explore the racial/ethnic disparities in PAD-related hospitalizations including presence of PAD with chronic limb threatened ischemia (CLI), amputation, in-hospital mortality, length of hospital stays and estimated medical costs. Race-ethnicity groups included non-Hispanic White, Black, Hispanic, Asian or Pacific Islander, Native American, and others (multiple races). Regression analyses adjusted for age, gender, Charlson Comorbidity Index, primary payer, patient location, bed size of the admission hospital, geographic region of the hospital, and rural/urban location of the hospital.Results: A total of 341,480 PAD hospitalizations were identified. Compared with non-Hispanic Whites, Native Americans had the highest odds of PAD with CLI (OR = 1.77, 95% CI: 1.61, 1.95); Black (OR = 1.71, 95% CI: 1.66, 1.76) and Hispanic (OR = 1.36, 95% CI: 1.31,1.41) patients had higher odds of amputation; Asian or Pacific Islanders had a higher mortality (OR = 1.20, 95% CI: 1.01,1.43), whereas Black (OR = 0.81, 95% CI: 0.76, 0.87) patients has a lower mortality; Asian or Pacific Islanders incurred higher overall inpatient costs (Margin = 30093.01, 95% CI: 28827.55, 31358.48) and most prolonged length of stay (IRR = 0.14, 95% CI: 0.09, 0.18).Conclusions: Our study identified elevated odds of amputation among Hispanic patients hospitalized with PAD as well as higher hospital mortality and medical expenses among Asian or Pacific Islander PAD inpatients. These two demographic groups were previously thought to have a lower risk for PAD and represent important populations for further investigation.

Abstract 17075: Impact of Peripheral Artery Disease on Outcomes Following Admission for Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nino Mihatov ◽  
Robert W Yeh ◽  
Eunhee Choi ◽  
Changyu Shen ◽  
Sahil A Parikh ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Peripheral Artery Disease ◽  
Circulatory Support ◽  
Complication Rates ◽  
Medicare Beneficiaries ◽  
Peripheral Artery ◽  
Adjusted Risk ◽  
Artery Disease ◽  
The Impact

Introduction: Contemporary in-hospital mortality rates for patients presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remain as high as 50%. The impact of comorbid lower extremity peripheral artery disease (LE-PAD) is unknown. Hypothesis: LE-PAD is associated with higher morbidity and mortality in patients presenting with CS and AMI. Methods: Medicare beneficiaries hospitalized with CS related to AMI from 10/2015-6/2017 were identified. PAD status was defined by the inpatient billing codes present in the year prior to presentation. Outcomes included in-hospital mortality, amputation, peripheral revascularization, and 6-month mortality. Adjusted regression models were used to evaluate outcomes. A subgroup analysis included patients requiring mechanical circulatory support (MCS). Results: Among 45,144 patients, 5.9% (N=2,651) had LE-PAD. The average age was 77.8±7.9, 59.8% were male and 83.0% were white. Cumulative in-hospital mortality was 46.8%, with greater risk among LE-PAD patients (55.2% vs 46.3%; adjusted OR 1.52, 95% CI 1.39-1.65). LE-PAD patients also had greater adjusted risk of in-hospital amputation (1.5% vs 0.2%; OR 3.23, 95% CI: 2.16-4.83), peripheral revascularization rates (1.4% vs 0.4%; OR 1.54, 95% CI: 1.06-2.23), and 6-month mortality (43.2% vs 23.7%; HR 2.06, 95% CI: 1.80-2.35). MCS was less frequently utilized in LE-PAD (20.1% vs. 38.1%, p<0.01). Adjusted in-hospital mortality, amputation and peripheral revascularization rates were comparable between LE-PAD and non-LE-PAD patients who received MCS. Non-MCS LE-PAD patients had a 2.28 fold higher adjusted 6-month mortality compared with MCS LE-PAD patients (95% CI 1.60-3.11; Figure). Conclusions: Comorbid PAD is associated with worse limb outcomes and mortality among patients with AMI and CS. Although MCS was less likely to be used in LE-PAD patients, in-hospital mortality and limb complication rates were comparable to non-LE-PAD MCS patients.

Abstract 15937: Gender Disparities in Presentation and Outcomes for Patients Undergoing Endovascular Lower Extremity Interventions for Peripheral Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Elizabeth M Lancaster ◽  
Bian Wu ◽  
Joel Ramirez ◽  
James Iannuzzi ◽  
Michael S Conte ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Hospital Mortality ◽  
Peripheral Artery Disease ◽  
Severe Disease ◽  
Functional Decline ◽  
Multivariable Analysis ◽  
National Database ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Gender Based

Introduction: Although data suggests higher rates of functional decline and inferior outcomes in women compared to men after interventions for peripheral artery disease (PAD), women remain underrepresented in contemporary studies. We used a large national database to better understand gender-based differences in presentation and outcomes for patients undergoing endovascular treatment for PAD. Methods: Patients in the Vascular Quality Initiative (VQI) database that underwent lower extremity (LE) endovascular interventions for symptomatic PAD from 2010-2019 were included. Descriptive statistics and multivariable analysis were performed. Results: 128,688 patients (40% female) underwent endovascular LE interventions for symptomatic PAD. Women were more likely to have chronic limb threatening ischemia compared to men (54% vs 51%) and more likely to have a preoperative ABI <0.4 (20% vs 14%). Compared to men, women were older (mean [SD]: 68 [11] vs 70 [12]), more likely to be Black (19% vs 14%), and less likely to be smokers (34% vs 36%), diabetic (50% vs 54%), have CAD (28% vs 35%), or be on dialysis (8% vs 9%) (Table 1). Women were less likely to have exclusively infrapopliteal interventions (8% vs 14%) compared to men (p<0.001 for all). Despite shorter procedural times in women, female gender was an independent predictor of in hospital mortality (OR 1.25, 95% CI 1.09-1.44) in a hierarchical multivariable model adjusting for age, race, smoking, and comorbidities. Women were more likely to be discharged to a rehab or nursing home (11% vs 10%, p< 0.001) and less likely to be taking a statin medication (73% vs 78%, p<0.001). Conclusions: Compared to men, women undergoing endovascular LE interventions for PAD are older, present with more severe disease, and have higher adjusted rates of in hospital mortality. More aggressive screening and medical treatment for PAD in women is needed to address these gender-based differences in disease presentation and clinical outcomes.

scholarly journals Atrial fibrillation and COVID-19 in older patients: a complex, dangerous, association. An analysis of the GeroCovid Registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Fumagalli ◽  
G Pelagalli ◽  
C Trevisan ◽  
S Del Signore ◽  
S Volpato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Hospital Mortality ◽  
Peripheral Artery Disease ◽  
Older Patients ◽  
Cardiac Diseases ◽  
Peripheral Artery ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf the GeroCovid Investigators Introduction. Atrial fibrillation (AF) is the most frequent arrhythmia diagnosed in elderly patients. It often associates with disabling complications, such as stroke and systemic embolism. COVID-19 severely affects older subjects, who show a particularly high mortality, often related to relevant alterations in coagulation and inflammation cascade.  Purpose. Aim of this study was to evaluate how the presence of a prevalent form of AF (at admission or in clinical history) influenced the clinical course of COVID-19 in an aged in-hospital population. Methods. We studied the acute patients included in GeroCovid, a multicenter retrospective-prospective registry designed by the Italian Society of Gerontology and Geriatric Medicine and the Norwegian Geriatrics Society. GeroCovid, independently of the healthcare setting and without exclusion criteria, enrolled subjects aged &gt;60 years to analyze risk factors, signs, symptoms and outcomes of COVID-19 in older people. For the purpose of this study, only the acute, in-hospital, cohort was evaluated. Results. Between March 1st and June 6th 2020, 2474 patients were enrolled in GeroCovid. Of these, 806 (32.6%) were assisted in hospital, for an acute condition (age: 79 ± 9 years; men: 51.7%). The prevalence of AF was 21.8%. Patients with the arrhythmia were older (82 ± 8 vs. 77 ± 9 years; p &lt; 0.001) and with a higher CHA2DS2-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5; p &lt; 0.001). The prevalence of almost all comorbidities was higher in AF patients (in particular, hypertension, cardiac diseases, diabetes, heart failure, peripheral artery disease, chronic renal failure, COPD, stroke, obesity). At multivariable analysis, advanced age (p = 0.010), an increased number of white blood cells (p = 0.031), the presence of cardiac diseases (p &lt; 0.001), peripheral artery disease (p = 0.030) and of signs or symptoms of heart failure (p = 0.003) characterized older patients with AF. In-hospital mortality was significantly higher in patients with the arrhythmia (36.9 vs. 27.5%; OR = 1.55, 95%CI = 1.09-2.20; p = 0.015). A multivariable logistic regression model showed that AF was an independent predictor of mortality (p = 0.021), such as male gender (p = 0.014) and the presence of peripheral artery disease (p = 0.003). COPD, stroke, chronic renal failure, diabetes and obesity were deleted from the final model. Conclusions. AF is frequently observed in older patients with COVID-19. Subjects with both conditions have a more complex clinical status and show a higher in-hospital mortality, thus requesting a particularly careful and intensive management.

Abstract 19700: Recent Trends in Procedure Type, Morbidity and In-hospital Outcomes of Patients With Peripheral Artery Disease: Data From the Brazilian Public Health System

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bruno R Nascimento ◽  
Luisa C Brant ◽  
Maria Letícia L Lana ◽  
Eduardo L Lopes ◽  
Antônio Luiz P Ribeiro
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Health System ◽  
Peripheral Artery Disease ◽  
Public Health System ◽  
Treatment Modalities ◽  
Peripheral Artery ◽  
Hospital Outcomes ◽  
Recent Trends ◽  
Artery Disease

Introduction: The prevalence of peripheral artery disease (PAD) is rising worldwide, with a considerable impact on health care systems. We aimed to characterize the recent trends in surgical, percutaneous and clinical therapeutic procedures and in-hospital outcomes of PAD among all hospitalized patients in the Brazilian Public Health System between 2008 and 2012. Methods: Nationwide data of all hospitalizations in the Brazilian Public Health System (DataSUS) database in 2008, 2010, and 2012 were analyzed regarding the frequency of hospitalizations due to PAD (endovascular - EVR, surgical revascularizations - SR and clinical treatment - CT), length of hospital stay and in-hospital mortality and associated costs to the health system. Results: The number of hospitalizations related to PAD (EVR, SR and CT) remained stable from 2008 to 2012: 28,091 and 28,151 respectively, accounting for 0.25% and 0.24% of all in-hospital procedures. However, there was a significant change in the proportions of treatment modalities used in this period. In 2008: SR = 8,001 (29%), EVR = 3,207 (11%) and CT = 16,887 (60%); in 2010: SR = 7,999 (30%), EVR = 4,020 (15%) and CT: 14,849 (55%); and in 2012: SR = 7,882 (28%), EVR = 5,044 (18%) and CT = 15,225 (54%); p<0.001. The results show a 57% increase in EVR, and a 9.8% decrease in CT in this period. Total costs raised 23%, from US$ 18.6 million in 2008 to R$ 22.9 million in 2012 (p< 0.001), with a marked 92% increase in EVR costs (R$ 5.3 to 10.0 million), compared to SR (11%) and CT (30%). Global mean hospital days did not change from 2008 to 2012 (5.8 to 5.7 days), whereas it decreased for EVR (5.7 to 4.8, p<0,001). Hospital mortality decreased from 2008 to 2012 for EVR (2.0 to 1.4%, p=0.048), increased for CT (5.1 to 5.8%, p=0.002) and remained stable for SR (8.5 to 8.8%, p=0.44). Overall mortality, however, increased from 6.2% in 2008 to 6.7% in 2012 (p=0.004). Conclusion: There is an increasing proportion of EVR for PAD in Brazil, with a concomitant increase in costs, mainly related to these procedures. Our administrative data-based analysis depicts the significant rise of overall PAD mortality in Brazil, especially in clinically treated patients, emphasizing the need of controlling PAD risk factors and promoting its early diagnosis and effective management.

Treating Peripheral Artery Disease in the Wake of Rising Costs and Protracted Length of Stay

2017 ◽  
Vol 44 ◽  
pp. 253-260 ◽  
Author(s):  
Grace J. Wang ◽  
Benjamin M. Jackson ◽  
Paul J. Foley ◽  
Scott M. Damrauer ◽  
Venkat Kalapatapu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals National Trends for Peripheral Artery Disease and End Stage Renal Disease From the National Inpatient Sample Database

2021 ◽  
Vol 27 ◽  
pp. 107602962110256
Author(s):  
Frank De Stefano ◽  
Luis H. Paz Rios ◽  
Brian Fiani ◽  
Jawed Fareed ◽  
Alfonso Tafur
Keyword(s):  
Length Of Stay ◽  
Renal Disease ◽  
Peripheral Artery Disease ◽  
End Stage Renal Disease ◽  
High Risk Population ◽  
National Inpatient Sample ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Peripheral artery disease (PAD), and subsequent chronic limb-threatening ischemia (CLTI), are frequently encountered among patients with end-stage renal disease (ESRD). Their coexistence is less favorable in comparison to patients with ESRD alone. We sought to investigate trends, comorbidities, determinants for cost, and prognostic outcomes in patients with concomitant ESRD and PAD. A retrospective analysis was performed using data from the National Inpatient Sample database from the years 2005-2014. ICD-9 codes were used to identify patients with diagnoses of PAD, CLTI, and ESRD. Pearson’s Chi-square, T-test, ANOVA, and multivariate binary logistic regression were used in this analysis. 7,214,843 patients with ESRD were identified. Of these, 123,499 patients were diagnosed with PAD and 102,447 with CLTI. Compared to ESRD alone, mortality rates increased with PAD and CLTI (5.7% vs. 13.9% vs. 15.9%, P < 0.001). Length of stay in days (7.3 vs. 10.2 vs. 11.1, P < 0.001) and in-hospital costs (59,872 vs. 85,866 vs. 89,016, P < 0.001) were higher with PAD and CLTI, respectively. CLTI demonstrated the highest independent predictor of mortality [OR = 6.93 (6.43-7.46), P < 0.001]. A decreasing trend in the rate of PAD (2005: 1.9% vs. 2014: 1.4%, P < 0.001) and CLTI (2005: 1.6% vs. 2014: 1.1%, P < 0.001) was noted. The presence of coexisting PAD, and furthermore CLTI, in patients with ESRD significantly raised in-hospital mortality, cost, and length of stay. A negative trend in rates of PAD and CLTI were observed. Proactive identification of this high-risk population may lead to accurate diagnosis and tailored therapeutic strategies.

scholarly journals Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease

2020 ◽  
Vol 40 (8) ◽  
pp. 1808-1817 ◽  
Author(s):  
J. Aaron Barnes ◽  
Mark A. Eid ◽  
Mark A. Creager ◽  
Philip P. Goodney
Keyword(s):  
Diabetes Mellitus ◽  
Native American ◽  
High Risk ◽  
Peripheral Artery Disease ◽  
Low Socioeconomic Status ◽  
Rural Areas ◽  
Significant Risk ◽  
The United States ◽  
Peripheral Artery ◽  
Artery Disease

Peripheral artery disease (PAD) stems from atherosclerosis of lower extremity arteries with resultant arterial narrowing or occlusion. The most severe form of PAD is termed chronic limb-threatening ischemia and carries a significant risk of limb loss and cardiovascular mortality. Diabetes mellitus is known to increase the incidence of PAD, accelerate disease progression, and increase disease severity. Patients with concomitant diabetes mellitus and PAD are at high risk for major complications, such as amputation. Despite a decrease in the overall number of amputations performed annually in the United States, amputation rates among those with both diabetes mellitus and PAD have remained stable or even increased in high-risk subgroups. Within this cohort, there is significant regional, racial/ethnic, and socioeconomic variation in amputation risk. Specifically, residents of rural areas, African-American and Native American patients, and those of low socioeconomic status carry the highest risk of amputation. The burden of amputation is severe, with 5-year mortality rates exceeding those of many malignancies. Furthermore, caring for patients with PAD and diabetes mellitus imposes a significant cost to the healthcare system—estimated to range from $84 billion to $380 billion annually. Efforts to improve the quality of care for those with PAD and diabetes mellitus must focus on the subgroups at high risk for amputation and the disparities they face in the receipt of both preventive and interventional cardiovascular care. Better understanding of these social, economic, and structural barriers will prove to be crucial for cardiovascular physicians striving to better care for patients facing this challenging combination of chronic diseases.

Cost Analysis of Initial Treatment With Endovascular Revascularization, Open Surgery, or Primary Major Amputation in Patients With Peripheral Artery Disease

2018 ◽  
Vol 25 (4) ◽  
pp. 504-511 ◽  
Author(s):  
Linda Tang ◽  
Sharath C. V. Paravastu ◽  
Shannon D. Thomas ◽  
Elaine Tan ◽  
Eric Farmer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Peripheral Artery Disease ◽  
Endovascular Therapy ◽  
Initial Treatment ◽  
Open Surgery ◽  
Major Amputation ◽  
Peripheral Artery ◽  
Endovascular Revascularization ◽  
Artery Disease ◽  
Cost Per Admission

Purpose: To compare the total initial treatment costs for open surgery, endovascular revascularization, and primary major amputation within a single-payer healthcare system. Methods: A multicenter, retrospective analysis was undertaken to evaluate 1138 patients with symptomatic peripheral artery disease (PAD) who underwent 1017 endovascular procedures, 86 open surgeries, and 35 major amputations between 2013 and 2016. A cost-mix analysis was performed on individual patient data generated for selected diagnosis-related groups. Mean costs are presented with the 95% confidence interval (CI). Results: There was no intergroup difference in demographics or private health insurance status. However, the amputation group had a higher proportion of emergency procedures (68.6% vs 13.3% vs 27.9%, p<0.001) and critical limb ischemia (88.6% vs 35.9% vs 37.2%, p<0.001) compared with the endovascular therapy and open surgery groups, respectively. The endovascular revascularization group spent less time in hospital and used fewer intensive care unit (ICU) resources compared with the open surgery and major amputation groups (hospital length of stay: 3.4 vs 10.0 vs 20.2 days, p<0.01; ICU: 2.4 vs 22.6 vs 54.6 hours, p<0.01), respectively. While mean prosthetic and device costs were higher in the endovascular group [AUD$2770 vs AUD$1658 (open) and AUD$1219 (amputation), p<0.01], substantial disparities were observed in costs associated with longer operating theater times, length of stay, and ICU utilization, which resulted in significantly higher costs in the open and amputation groups. After adjusting for confounders, the AUD$18,396 (95% CI AUD$16,436 to AUD$20,356) mean cost per admission for the endovascular revascularization group was significantly less (p<0.001) than the open surgery (AUD$31,908, 95% CI AUD$28,285 to AUD$35,530) and major amputation groups (AUD$43,033, 95% CI AUD$37,706 to AUD$48,361). Conclusion: Endovascular revascularization procedures for PAD cost the health payer less compared with open surgery and primary amputation. While devices used to deliver contemporary endovascular therapy are more expensive, the reduction in bed days, ICU utilization, and related hospital resources results in a significantly lower mean total cost per admission for the initial treatment.

Associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm – a grin without a cat!

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Hisato Takagi ◽  
Takuya Umemoto
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Peripheral Artery Disease ◽  
Literature Search ◽  
Systematic Literature Search ◽  
Peripheral Artery ◽  
Epidemiological Evidence ◽  
Abdominal Aortic ◽  
Artery Disease ◽  
Meta Analyses

Abstract. Both coronary and peripheral artery disease are representative atherosclerotic diseases, which are also known to be positively associated with presence of abdominal aortic aneurysm. It is still controversial, however, whether coronary and peripheral artery disease are positively associated with expansion and rupture as well as presence of abdominal aortic aneurysm. In the present article, we overviewed epidemiological evidence, i. e. meta-analyses, regarding the associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm through a systematic literature search. Our exhaustive search identified seven meta-analyses, which suggest that both coronary and peripheral artery disease are positively associated with presence of abdominal aortic aneurysm, may be negatively associated with expansion of abdominal aortic aneurysm, and might be unassociated with rupture of abdominal aortic aneurysm.

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