Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

Abstract

Background The aim of our study was to evaluate whether treatments for peripheral artery disease changed in two different cohorts identified in 2002 and 2008, and whether this had an impact on mortality and major clinical outcomes after six years of follow-up. Methods Using administrative health databases of the largest region in Northern Italy, we identified patients admitted to hospital for peripheral artery disease in 2002 and 2008. Both cohorts were followed for six years. All cause death, acute coronary syndrome, stroke and major amputations, cardiovascular prevention drugs and revascularization procedures were collected. Incidence of events was plotted using adjusted cumulative incidence function estimates. The risk, for each outcome, was compared between 2002-2008 and 2008-2014 using a multivariable Fine and Gray's semiparametric proportional subdistribution hazards model. Results In 2002 and 2008, 2885 and 2848 patients were identified. Adjusting for age, sex, Charlson comorbidity index and severity of peripheral artery disease we observed a significant reduction (in 2008 vs. 2002) in the risk of acute coronary syndrome (28%), stroke (27%) and major amputation (17%). No change was observed in the risk of death. The percentages of patients with peripheral artery revascularizations, during the hospital stay, increased: 43.8% in 2002 vs. 49.0% in 2008, p < 0.001. From 2002 to 2008 there was a significant absolute increase in the prescription of lipid-lowering drugs (+18%), antiplatelets (+7.2%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (+11.8%), p < 0.001. Conclusions In six years of follow-up we observed a reduction in risk of major cardiovascular events in 2008-2014 in comparison with the 2002-2008 cohort. Increasing use of revascularization interventions and cardiovascular prevention drugs could have contributed to the better prognosis.

Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review

“…NR NR Arinze et al (2018) [ 61 ] OptumLabs Data Warehouse from 2004 to 2014 AMI, stroke AMI: 410; stroke: 434, 434.0, 434.00, 434.01, 434.1, 434.10, 434.11, 434.9, 434.90, 434.91 (ICD-9). NR NR Baviera et al (2018) [ 62 ] Administrative health databases of Lombardy from 2002 to 2014 ACS, stroke, all cause death, major amputation ACS: 410.xx, 411; stroke: 430, 431, 434.xx, 436, 433.11; major amputation: 84.10, 84.13, 84.14, 84.15, 84.16, 84.17, 84.18, 84.19 (ICD-9). NR Authors state that diagnoses were retrieved from hospital discharge charts, which have been validated across all Italian hospitals for reimbursement purposes.…”

The influence of diabetes on temporal trends in lower extremity revascularisation and amputation for peripheral artery disease: A population‐based repeated cross‐sectional analysis

“…Studies of U.S. Medicare data and the National Inpatient Sample have also noted an increase in endovascular revascularisation with a concomitant decrease in open revascularisation, [16][17][18][19] as did Australian 20 and several European studies. 23 16,[19][20][21][22][23] although some studies found stable rates. 24,26 Many studies of minor amputation rates identified a mild increase.…”

Editor's presentation

“…Peripheral artery diseases constitute ominous clinical conditions with still a high burden of mortality due to poor management. 8,9 On the other hand, the growing relevance of cost-effectiveness analysis in clinical practice has led to the publication of cost-effectiveness papers in clinical journals, also outside the borders of pharmacoeconomics journals. 10 This issue contains an Australian healthcare cost-effectiveness analysis regarding low-dose rivaroxaban in 1000 hypothetical individuals with peripheral artery disease or carotid artery disease, profiled on the COMPASS trial, using a Markov model.…”