Prioritization of treatments for lower extremity peripheral artery disease in low- and middle-income countries

Fowkes, F. G. R.; Forster, Rachel; Levin, Carol; Naidoo, Nadraj; Roy, Ambuj; Shu, Chang; Spertus, John A.; Fang, Kun; Bechara-Zamudio, Luis; Catalano, M.; Visonà, Adriana; Nikol, Sigrid; Fletcher, J.; Jaff, Michael R.; Hiatt, William R.; Norgren, Lars

doi:10.23736/s0392-9590.16.03716-0

Cited by 13 publications

(9 citation statements)

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“…Encouragement might be given to incorporating non-communicable disease management into existing primary care systems in LMICs which tend to prioritise infection treatment and control. For example, providing simple inexpensive treatments to prevent major cardiovascular events and mortality in patients with PAD could be given priority [ 18 ]. Greater emphasis could be given to prevention overall including dealing with risk factors for both communicable and non-communicable diseases, such as smoking and diabetes mellitus, which increase the risk of both tuberculosis and PAD.…”

Section: Need For Increasing Awareness Of Interdependency Between Com...mentioning

confidence: 99%

The Global Epidemiological Transition in Cardiovascular Diseases: Unrecognised Impact of Endemic Infections on Peripheral Artery Disease

Agius

Cutts

Song

et al. 2022

J Epidemiol Glob Health

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An epidemiological transition in the prevalence of peripheral artery disease (PAD) is taking place especially in low- and middle-income countries (LMICs) where an ageing population and adoption of western lifestyles are associated with an increase in PAD. We discuss the limited evidence which suggests that infection, potentially mediated by inflammation, may be a risk factor for PAD, and show by means of an ecological analysis that country-level prevalence of the major endemic infections of HIV, tuberculosis and malaria are associated with the prevalence of PAD. While further research is required, we propose that scientists and health authorities pay more attention to the interplay between communicable and non-communicable diseases, and we suggest that limiting the occurrence of endemic infections might have some effect on slowing the epidemiological transition in PAD.

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Section: Need For Increasing Awareness Of Interdependency Between Com...mentioning

confidence: 99%

The Global Epidemiological Transition in Cardiovascular Diseases: Unrecognised Impact of Endemic Infections on Peripheral Artery Disease

Agius

Cutts

Song

et al. 2022

J Epidemiol Glob Health

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“…Although the correlation between MLLA rates and endovascular procedures was also significantly positive, it was 40% lower than the correlation with open surgeries, in agreement with a previous study that suggested that patients undergoing endovascular treatment will evolve with fewer MLLA rates. 33 It has been previously suggested that developing countries should focus their efforts on primary intervention (prevention) in order to reduce the occurrence of lower limb amputation 34 ; in a second step, investment should be made in early diagnosis and clinical treatment; and finally, accessibility to surgical/interventional treatments should be improved. 34 The findings of this study suggest Open access that the State of Paraná is presently at the second stage, in which more investment should be made in early diagnosis and clinical treatment.…”

Section: Open Accessmentioning

confidence: 99%

“…33 It has been previously suggested that developing countries should focus their efforts on primary intervention (prevention) in order to reduce the occurrence of lower limb amputation 34 ; in a second step, investment should be made in early diagnosis and clinical treatment; and finally, accessibility to surgical/interventional treatments should be improved. 34 The findings of this study suggest Open access that the State of Paraná is presently at the second stage, in which more investment should be made in early diagnosis and clinical treatment. But the first stage must be improved also, with a better effectiveness of primary healthcare to reduce MLLA rates.…”

Section: Open Accessmentioning

confidence: 99%

Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil

et al. 2020

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ObjectiveThe aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.MethodData on MLLA, revascularisation surgeries, diagnostic exams and healthcare coverage were obtained from the Brazilian Public Hospital Information System. Socioeconomic data were obtained from the Brazilian Institute of Geography and Statistics. Spatial autocorrelation of the MLLA rates was tested using Moran’s I method. Multivariate spatial regression models using ordinary least squares regression (OLS) and geographically weighted regression (GWR) were used to identify the variables significantly correlated with MLLA.ResultsA total of 5270 MLLA were included in the analysis. Mean MLLA rates were 24.32 (±18.22)/100 000 inhabitants, showing a positive global spatial autocorrelation (Moran’s I=0.66; p<0.001). Queen contiguity matrix demonstrates that MLLA rates ranged from 7.6 to 46.6/100 000 with five large clusters of high MLLA rates. OLS showed that four of the nine studied variables presented significant spatial correlation with MLLA rates. Colour Doppler ultrasound showed a negative association (p<0.001), while revascularisation surgeries and illiteracy showed a positive correlation (p<0.01). GWR presented the best model (adjusted R2=0.77) showing that the predictors differentially affect the MLLA rates geographically.ConclusionThe high MLLA rates in some regions of the state are influenced by the high rate of illiteracy and low utilisation rate of colour Doppler, indicating a social problem and difficulty in accessing health. On the other hand, the high rates of revascularisation surgeries are related to higher MLLA rates, possibly due to delayed access to specialised hospitals. This indicates that attention must be given to population access to public healthcare in the State of Paraná in order to ensure proper and timely medical attention.

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“… 7 , 8 An international consensus panel performed a systematic review and concluded such prevention should be a high priority in the management of patients with PAD, particularly in low- and middle-income countries. 9 Despite such recommendations, it is evident that antithrombotic treatment has been far from optimal, even following revascularization. 10 The role of aspirin as the most frequently used drug has been questioned, and the slightly more effective drug, clopidogrel, 11 has been used to varying extent.…”

Section: Introductionmentioning

confidence: 99%

World regional differences in outcomes for patients with peripheral artery disease: Insights from the EUCLID trial

et al. 2021

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Regional variations exist in the epidemiology of peripheral artery disease (PAD), in comorbidities, use of secondary prevention, and outcomes. Large studies of these variations in worldwide populations are rare. The EUCLID (Examining Use of tiCagreLor In peripheral artery Disease) trial included 13,885 patients with PAD from four geographical regions (Central/South America, Europe, Asia, North America) and compared monotherapy with ticagrelor and clopidogrel. Inclusion criteria were either an ankle–brachial index < 0.80 or a prior revascularization. The primary efficacy endpoint was time to first occurrence of any event in the composite of cardiovascular death, myocardial infarction, or ischemic stroke and did not differ between the study arms. This post hoc analysis of EUCLID confirmed that regional differences occurred in the inclusion criteria with more prior revascularization in North America (73.9%) and Asia (72.5%) compared with Central/South America (34.0%) and Europe (51.6%). The characteristics of patients also differed. Prior amputation at baseline was most frequent in Central/South America (6.3%) compared with other regions (1.6–2.8%). A history of stroke was most common in Asia, coronary heart disease in North America, and diabetes in Central/South America compared with other regions. The incidence of outcomes in patients with PAD varied by region. North America had the highest rate of the primary combined endpoint (5.97 events/100 patient-years). Corresponding rates were 4.80, 3.95, and 3.87 for Asia, Europe, and Central/South America, respectively. Hospitalization for acute limb ischemia (events/100 patient-years) was most frequent in Europe (0.75) and North America (0.74) compared with Asia (0.60) and Central/South America (0.33). Adjustment for inclusion criteria and relevant PAD characteristics did not have a major impact on these regional differences. Further adjustment for concomitant disease, risk factors, and preventive medication modified the regional differences only marginally. In conclusion, substantial regional differences were found in cardiovascular and limb outcomes in patients with PAD and were not explained by variation in the category of included patients, concomitant disease, risk factors, and prevention. Such differences, which may be due to variation in other factors such as background population rates or clinical care, need to be considered when designing and interpreting large international studies (ClinicalTrials.gov Identifier: NCT01732822).

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Prioritization of treatments for lower extremity peripheral artery disease in low- and middle-income countries

Cited by 13 publications

References 0 publications

The Global Epidemiological Transition in Cardiovascular Diseases: Unrecognised Impact of Endemic Infections on Peripheral Artery Disease

The Global Epidemiological Transition in Cardiovascular Diseases: Unrecognised Impact of Endemic Infections on Peripheral Artery Disease

Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil

World regional differences in outcomes for patients with peripheral artery disease: Insights from the EUCLID trial

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