Gender Differences in Outpatient Peripheral Artery Disease Management in Germany: A Population Based Study 2009–2018

Messiha, Daniel; Petrikhovich, Olga; Lortz, Julia; Mahabadi, Amir A.; Hering, Ramona; Schulz, Mandy; Rassaf, Tienush; Rammos, Christos

doi:10.1016/j.ejvs.2022.02.007

Cited by 19 publications

(13 citation statements)

References 32 publications

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“…International studies have suggested that women with PAD are less often prescribed optimal cardioprotective therapy 28 . Women in our cohort were prescribed less lipid‐lowering medication.…”

Section: Discussionmentioning

confidence: 77%

“…International studies have suggested that women with PAD are less often prescribed optimal cardioprotective therapy. 28 Women in our cohort were prescribed less lipid-lowering medication. Prescriber concerns during childbearing years should not impact women above this age range, hence research into the specific reasons is required.…”

Section: Impact Of Ethnicity Sex and Comorbiditiesmentioning

confidence: 99%

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The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

Hart

Xue

Khashram

2023

ANZ Journal of Surgery

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BackgroundCardiovascular disease guidelines recommend that patients with established peripheral artery disease (PAD) are prescribed antihypertensive, lipid‐lowering, and antiplatelet medication to reduce cardiovascular ischaemic events. However, the prescribing of these medications for patients with PAD within New Zealand (NZ) remains undefined.MethodsThis was a retrospective observational cohort study of patients in the Midland region of NZ, that underwent PAD‐related percutaneous and surgical intervention between 1st January 2010 and 31st December 2021. Patient level data was collected. The primary outcome was prescribing of cardioprotective medications either before or within 1 year of incident procedure. Secondary outcome was overall survival.ResultsThere were 2547 patients included. Antihypertensive prescription occurred in 80.7%, lipid‐lowering in 77.4% and antithrombotic in 89.9%. Concomitant ischaemic heart disease increased prescription of cardioprotective medications. Women were prescribed less lipid‐lowering medication compared to men. Māori men were prescribed less antiplatelet medication compared to non‐Māori men. On univariate analysis lipid‐lowering and antiplatelet medication showed survival advantage, while antihypertensive and anticoagulation did not. After adjustment for age, sex, end stage renal failure and presence of chronic limb‐threatening ischaemia, best medical therapy was associated with better survival (HR 0.88, 95% CI 0.79–0.98, P = 0.02).ConclusionThis study highlights areas of deficiency in prescribing of cardioprotective medication in this high‐risk group. These could be targets for national quality improvement initiatives.

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Section: Discussionmentioning

confidence: 77%

Section: Impact Of Ethnicity Sex and Comorbiditiesmentioning

confidence: 99%

The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

Hart

Xue

Khashram

2023

ANZ Journal of Surgery

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“…PAD prevalence (as defined as ABI < 0.9) in high-income countries is widely reported to be increasing [ 1 , 2 , 12 ]. This may be to the result of an aging population [ 25 ] in addition to capture of asymptomatic or mildly symptomatic patients in these estimates.…”

Section: Discussionmentioning

confidence: 99%

“…These cases are observed as short-distance intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI). CLTI is the experience of lower limb rest pain, chronic ulceration and gangrene, and probably represents around 10% of all PAD [ 9 , 11 , 12 ]. The annual incidence of CLTI has previously been estimated at 500–1000 new cases per million people in Western countries [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

Hart

Xue

Davis-Havill

et al. 2022

JCM

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The epidemiology of severe PAD, as characterized by short-distance intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI), remains undefined in New Zealand (NZ). This was a retrospective observational cohort study of the Midland region in NZ, including all lower limb PAD-related surgical and percutaneous interventions between the 1st of January 2010 and the 31st of December 2021. Overall, 2541 patients were included. The mean annual incidence of short-distance IC was 15.8 per 100,000, and of CLTI was 36.2 per 100,000 population. The annual incidence of both conditions was greater in men. Women presented 3 years older with PAD (p < 0.001). Patients with short-distance IC had lower ipsilateral major limb amputation at 30 days compared to CLTI (IC 2, 0.3% vs. CLTI 298, 16.7%, p < 0.001). The 30-day mortality was greater in elderly patients (<65 years 2.7% vs. ≥65 years 4.4%, p = 0.049), but did not differ depending on sex (females 36, 3.7% vs. males 64, 4.1%, p = 0.787). Elderly age was associated with a worse survival for both short-distance IC and CLTI. There was a worse survival for females with CLTI. In conclusion, PAD imposes a significant burden in NZ, and further research is required in order to reduce this disparity.

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“…In chronic peripheral artery disease (PAD), prior studies have found that women were older and had more comorbidities and more often inadequate medical treatments compared to men. 6,7 The main aim of the present study is to investigate differences between men and women regarding key baseline characteristics and clinical presentation and evaluate if there is a potential difference in major amputation and mortality during the first year after revascularization for ALI between men and women. A secondary aim is to investigate if there are differences associated with fasciotomy and major bleeding between men and women.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in outcomes after revascularization for acute lower limb ischemia: Propensity score adjusted analysis

Karonen,

Eek,

Butt

et al. 2024

World j. surg.

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BackgroundPrevious reports have suggested higher rates of mortality and amputation for female patients in acute lower limb ischemia (ALI). The aims of the present study were to investigate if there is a difference in mortality, amputation, and fasciotomy between the sexes.MethodsA retrospective cohort study of consecutive patients undergoing index revascularization for ALI between 2001 and 2018 was conducted. A propensity score was created through a logistic regression with female/male sex as an outcome. Cox regression analyses for 90‐day and 1‐year mortality, combining major amputation/mortality, and logistic regression for major bleeding and fasciotomy, were performed. All analyses were performed with and without adjusting for propensity score.ResultsA total of 709 patients were included in the study of which 45.9% were women. Mean age was 72.1 years. Females were older and had higher rates of atrial fibrillation, embolic disease, and lower estimated glomerular filtration rate, while men more often had anemia and chronic peripheral arterial disease. Mortality at 1 year was 21.2% for women and 14.7% for men. The adjusted hazard ratio for 1‐year mortality was 0.99 (95% CI 0.67–1.46). Fasciotomy was performed in 7.1% of female and 12.8% of male patients; the adjusted odds ratio was 0.52 (95% CI 0.29–0.91).ConclusionSex was not found to be an independent risk factor for mortality or combined major amputation/mortality after revascularization for acute lower limb ischemia, whereas women had lower odds of undergoing fasciotomy. Whether women are underdiagnosed or do not develop acute compartment syndrome in the lower leg as often as men should be evaluated prospectively.

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Gender Differences in Outpatient Peripheral Artery Disease Management in Germany: A Population Based Study 2009–2018

Cited by 19 publications

References 32 publications

The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

The prescribing of cardioprotective medications and the impact on survival for patients with peripheral artery disease that undergo intervention

The Incidence of Chronic Limb-Threatening Ischemia in the Midland Region of New Zealand over a 12-Year Period

Sex differences in outcomes after revascularization for acute lower limb ischemia: Propensity score adjusted analysis

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