Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis

Shan, Leonard; Yang, Limin; Tew, Michelle; Westcott, Mark J.; Spelman, Tim; Choong, Peter; Davies, Alun H.

doi:10.1016/j.ejvs.2022.07.051

Cited by 11 publications

(14 citation statements)

References 71 publications

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“…4,5 Our recent review demonstrated that whilst revascularisation in CLTI may lead to modest QOL benefits, amputation and conservative management may also maintain QOL. 2 However, interpretation of QOL outcomes is hampered by the lack of a CLTI-specific QOL instrument and significant weaknesses of best alternatives such as VascuQoL. 2,3,5 This study is thus a continuation of our group's work in developing a CLTI-specific QOL instrument using consumer and patient co-design.…”

Section: Introductionmentioning

confidence: 95%

“…2 However, interpretation of QOL outcomes is hampered by the lack of a CLTI-specific QOL instrument and significant weaknesses of best alternatives such as VascuQoL. 2,3,5 This study is thus a continuation of our group's work in developing a CLTI-specific QOL instrument using consumer and patient co-design.…”

Section: Introductionmentioning

confidence: 95%

“…Quality of life (QOL) is an established outcome measure 1 that is frequently used to evaluate and compare treatments for chronic limb-threatening ischemia (CLTI). 2,3 It is an outcome that matters to patients and is vital within a value-based healthcare system. 4,5 Our recent review demonstrated that whilst revascularisation in CLTI may lead to modest QOL benefits, amputation and conservative management may also maintain QOL.…”

Section: Introductionmentioning

confidence: 99%

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Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Shan,

Telianidis,

Westcott

et al. 2023

ANZ Journal of Surgery

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BackgroundQuality of life (QOL) is an outcome that matters to patients with chronic limb‐threatening ischemia (CLTI). However, we identified the lack of and need for a CLTI‐specific QOL instrument. Our group is developing this instrument which requires a deep understanding of patient perspectives of QOL in CLTI.MethodsQualitative inquiry with patient and public involvement was performed in accordance with the Standards for Reporting Qualitative Research. Reflexive thematic analysis of semi‐structured interviews was conducted within a constructivist‐interpretivist research paradigm. Data were organized and managed in NVivo. Techniques to enhance trustworthiness included maintaining an audit trail, member checking, mentoring, and peer‐debriefing. Patient and the public were consulted for feedback on codes, themes, and thematic maps.ResultsThirteen participants (median age: 74 years, range: 43–90 years) with a variety of patient demographics were interviewed. Four themes were developed on QOL in CLTI: (i) ‘independence as key to life satisfaction’, (ii) ‘change in identity when continuity is needed’, (iii) ‘coping with intractable disease’, and (iv) ‘not wanting to be alone’. Member checking with patient and public involvement confirmed the relevance and centrality of these themes to the lived experiences of patients with CLTI.ConclusionsThe thematic outputs contribute important insights into what QOL truly means to patients with CLTI and what matters for their QOL. The content validity of the new CLTI‐specific QOL instrument is improved by giving patients voice. This study highlights the value of qualitative inquiry and patient and public involvement in vascular surgical research.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Shan,

Telianidis,

Westcott

et al. 2023

ANZ Journal of Surgery

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“…The need for major lower extremity amputation is often the result of advanced comorbid medical conditions causing an end-stage atherosclerotic process wherein arterial perfusion does not meet the basal metabolic requirements of the extremity, resulting in ischemic pain or tissue loss . The implications of undergoing amputation are significant, resulting in decreased quality of life, economic potential, and life expectancy, with the annual costs of amputation in the US estimated to be over $10 billion annually …”

Section: Introductionmentioning

confidence: 99%

“…1 The implications of undergoing amputation are significant, resulting in decreased quality of life, economic potential, and life expectancy, with the annual costs of amputation in the US estimated to be over $10 billion annually. [2][3][4] The rates of amputation in the US are unequally distributed, disproportionately affecting patients from racial and ethnic minority groups, patients with lower socioeconomic status and increased comorbidities, and residents of specific geographic locations. 5,6 Of particular interest are the metropolitan areas of the US, where groups who are disproportionately affected by amputation predominantly reside and where, despite having the highest concentration of hospitals and specialty and primary care practitioners, patients continue to experience the highest amputation rates in the country on an absolute numbers basis.…”

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confidence: 99%

Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties

Kassavin,

Mota,

Ostertag-Hill

et al. 2024

JAMA Surg

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ImportanceSocial Determinants of Health (SDOH) have been found to be associated with health outcome disparities in patients with peripheral artery disease (PAD). However, the association of specific components of SDOH and amputation has not been well described.ObjectiveTo evaluate whether individual components of SDOH and race are associated with amputation rates in the most populous counties of the US.Design, Setting, and ParticipantsIn this population-based cross-sectional study of the 100 most populous US counties, hospital discharge rates for lower extremity amputation in 2017 were assessed using the Healthcare Cost and Utilization Project State Inpatient Database. Those data were matched with publicly available demographic, hospital, and SDOH data. Data were analyzed July 3, 2022, to March 5, 2023.Main outcome and MeasuresAmputation rates were assessed across all counties. Counties were divided into quartiles based on amputation rates, and baseline characteristics were described. Unadjusted linear regression and multivariable regression analyses were performed to assess associations between county-level amputation and SDOH and demographic factors.ResultsAmputation discharge data were available for 76 of the 100 most populous counties in the United States. Within these counties, 15.3% were African American, 8.6% were Asian, 24.0% were Hispanic, and 49.6% were non-Hispanic White; 13.4% of patients were 65 years or older. Amputation rates varied widely, from 5.5 per 100 000 in quartile 1 to 14.5 per 100 000 in quartile 4. Residents of quartile 4 (vs 1) counties were more likely to be African American (27.0% vs 7.9%, P &lt; .001), have diabetes (10.6% vs 7.9%, P &lt; .001), smoke (16.5% vs 12.5%, P &lt; .001), be unemployed (5.8% vs 4.6%, P = .01), be in poverty (15.8% vs 10.0%, P &lt; .001), be in a single-parent household (41.9% vs 28.6%, P &lt; .001), experience food insecurity (16.6% vs 12.9%, P = .04), or be physically inactive (23.1% vs 17.1%, P &lt; .001). In unadjusted linear regression, higher amputation rates were associated with the prevalence of several health problems, including mental distress (β, 5.25 [95% CI, 3.66-6.85]; P &lt; .001), diabetes (β, 1.73 [95% CI, 1.33-2.15], P &lt; .001), and physical distress (β, 1.23 [95% CI, 0.86-1.61]; P &lt; .001) and SDOHs, including unemployment (β, 1.16 [95% CI, 0.59-1.73]; P = .03), physical inactivity (β, 0.74 [95% CI, 0.57-0.90]; P &lt; .001), smoking, (β, 0.69 [95% CI, 0.46-0.92]; P = .002), higher homicide rate (β, 0.61 [95% CI, 0.45-0.77]; P &lt; .001), food insecurity (β, 0.51 [95% CI, 0.30-0.72]; P = .04), and poverty (β, 0.46 [95% CI, 0.32-0.60]; P &lt; .001). Multivariable regression analysis found that county-level rates of physical distress (β, 0.84 [95% CI, 0.16-1.53]; P = .03), Black and White racial segregation (β, 0.12 [95% CI, 0.06-0.17]; P &lt; .001), and population percentage of African American race (β, 0.06 [95% CI, 0.00-0.12]; P = .03) were associated with amputation rate.Conclusions and RelevanceSocial determinants of health provide a framework by which the associations of environmental factors with amputation rates can be quantified and potentially used to guide interventions at the local level.

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An Endovascular- Versus a Surgery-First Revascularization Strategy for Chronic Limb-Threatening Ischemia: A Meta-Analysis of Randomized Controlled Trials

Mufarrih,

Khan,

Qureshi

et al. 2024

The American Journal of Cardiology

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Quality of Life in Chronic Limb Threatening Ischaemia: Systematic Review and Meta-Analysis

Cited by 11 publications

References 71 publications

Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Patient perspectives of quality of life in chronic limb‐threatening ischemia: a qualitative study

Amputation Rates and Associated Social Determinants of Health in the Most Populous US Counties

An Endovascular- Versus a Surgery-First Revascularization Strategy for Chronic Limb-Threatening Ischemia: A Meta-Analysis of Randomized Controlled Trials

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