Long-Term Clinical Outcome After Endovascular Treatment in Patients With Intermittent Claudication due to Iliofemoral Artery Disease

Soga, Yoshimitsu; Yokoi, Hiroyoshi; Urakawa, Tomoko; Tosaka, Atsushi; Iwabuchi, Masashi; Nobuyoshi, Masakiyo

doi:10.1253/circj.cj-10-0077

Cited by 24 publications

(24 citation statements)

References 21 publications

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“…Unfortunately, this study was not able to identify the underlying reasons for the lack of guideline adherence. 36,37 Societal practice guidelines recommend lipid lowering drugs, antiplatelets, and ACEIs or ARBs as first line OPT in patients with symptomatic PAOD to help to prevent limb related or cardiovascular events. 3,4 Interestingly, adherence to the guideline recommendations varies considerably in the literature, and OPT prescription rates are infrequently reported and rarely distinguished by sex (Tables S5 and S6).…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Peters

Kreutzburg

Rieß

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS In 2018, women are still disadvantaged in terms of optimal pharmacological treatment for peripheral arterial occlusive disease after hospital discharge. Although presenting at older age and with more severe symptoms, women have a lower prescription prevalence of optimal pharmacological treatment, particularly with respect to lipid lowering drugs. The sex prescription gap did not narrow over time, despite an overall upward trend in prescription prevalence for both women and men. Objective: Optimal pharmacological treatment (OPT) for peripheral arterial occlusive disease (PAOD) includes prescription of lipid lowering drugs, antithrombotics, and antihypertensives to symptomatic patients affected by intermittent claudication or chronic limb threatening ischaemia. This study sought to determine sex disparities and time trends in prescription of OPT in this population (clinicaltrials.gov NCT03909022). Methods: Using data from the second largest insurance fund in Germany, BARMER, data on patients with an index admission for symptomatic PAOD between 1 January 2010 and 30 June 2018 with follow up until the end of 2018 were analysed. Sex disparities in post-discharge prescription status six months after index admission were tested and adjusted for patient and healthcare variables using bivariable tests and logistic regression analysis. Time trends in the prescription prevalence of OPT were analysed and tested. Results: There were 83 867 patients (mean age 71.9 years and 45.8% women) eligible for inclusion in the study. When compared with men, women had lower rates of prior outpatient care for PAOD (39.8% vs. 47.0%), were admitted more often with ischaemic rest pain (13.9% vs. 10.4%) and were older (74 vs. 70 y). After discharge, women had a lower rate of prescriptions for lipid lowering drugs (52.4% vs. 59.9%), while they received antihypertensive drugs more often (86.7% vs. 84.1%). We found evidence for a lower prescription prevalence of OPT in females (37.0% vs. 42.7%). Differences in patient and healthcare variables (e.g. demographics, comorbidities, prior treatment) between women and men explained 56% of this gap. The sex prescription gap did not narrow over time despite an overall upward trend in prescription prevalence for both women and men. Conclusion: Although presenting older and with more severe symptoms at the index admission for PAOD, women have a lower prescription prevalence of OPT compared with men, particularly with respect to lipid lowering drugs.

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Section: Discussionmentioning

confidence: 99%

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Peters

Kreutzburg

Rieß

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…13,17,[30][31][32][33] However, mortality data extending beyond 1-year post-intervention is scarce and many have focused only on reduced ejection fraction as a risk factor for increased mortality. 11,14,15 The study by Meltzer and colleagues is the only other to our knowledge that directly compared the outcomes of PAD patients with heart failure based on ejection fraction. 16 They similarly reported reduced 1-and 2-year survival in patients with a diagnosis of heart failure (75.3±3.4% 1-year and 64.3±4.5% 2-year survival) compared to those without a diagnosis of heart failure (89.4±1.3% 1-year and 82.3±1.8% 2-year survival rates), with no significant survival difference between the two heart failure groups stratified by ejection fraction (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] In addition to advanced age and non-ambulatory status, many studies have also identified other co-morbidities as independent risk factors for increased mortality and/or major amputation in CLI patients, including heart failure (HF), end-stage renal disease (ESRD), coronary artery disease (CAD), and diabetes mellitus (DM). [8][9][10][11][12][13][14][15][16] Cardiac co-morbidities are common in CLI patients, and the prevalence of HF has been reported to be 10-40% in this population. [8][9][10][11][12][13][14][15][16] Although HF has been identified as an important risk factor for increased mortality and/or amputation, most studies failed to stratify HF patients by left ventricular ejection fraction (EF) 10,12,13,17 or limited their evaluation to those with left ventricular systolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16] Cardiac co-morbidities are common in CLI patients, and the prevalence of HF has been reported to be 10-40% in this population. [8][9][10][11][12][13][14][15][16] Although HF has been identified as an important risk factor for increased mortality and/or amputation, most studies failed to stratify HF patients by left ventricular ejection fraction (EF) 10,12,13,17 or limited their evaluation to those with left ventricular systolic dysfunction. 11,14,15 Inadequate systemic perfusion as a consequence of HF may pose a threat to CLI patients by putting them at a higher risk for embolism.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

et al. 2017

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The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.

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“…For this reason, patients with this condition are treated mainly by surveillance walking therapy and/or drug therapy. 2 According to Soga et al, 3 the 5-year patency rate with endovascular therapy for iliac artery lesions was 85.2%. Hence, endovascular therapy has recently been applied positively, producing generally good results for the treatment of iliac artery lesions.…”

mentioning

confidence: 99%

Evaluation of Conservative Therapy for Intermittent Claudication

Hara

Tanemoto

2012

Circ J

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Long-Term Clinical Outcome After Endovascular Treatment in Patients With Intermittent Claudication due to Iliofemoral Artery Disease

Cited by 24 publications

References 21 publications

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Editor's Choice – Optimal Pharmacological Treatment of Symptomatic Peripheral Arterial Occlusive Disease and Evidence of Female Patient Disadvantage: An Analysis of Health Insurance Claims Data

Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction

Evaluation of Conservative Therapy for Intermittent Claudication

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