Association between diagnosis-to-limb revascularization time and clinical outcomes in outpatients with chronic limb-threatening ischemia: insights from the CLIPPER cohort

Selected in JAHA by Delphine Donzel

Peripheral artery disease can lead to limb-threatening ischemia, yet many patients face delays in revascularization, increasing the risk of major amputation. This study addresses the urgency of reducing these delays.

References:

Authors: Alexander C. Fanaroff, Elias J. Dayoub, Lin Yang, Kaitlyn Schultz, Omar I. Ramadan, Grace J. Wang, Scott M. Damrauer, Elizabeth A. Genovese, Eric A. Secemsky, Sahil A. Parikh, Ashwin S. Nathan, Maureen P. Kohi, Mitchell D. Weinberg, Michael R. Jaff, Peter W. Groeneveld, and Jay S. Giri, MD, MPH

Reference: J Am Heart Assoc. 2024;13:e033898.

DOI: 10.1161/JAHA.123.033898

Read the abstract

Objectives:

To describe the distribution of time from CLTI diagnosis to outpatient endovascular revascularisation (D2L time) and its association with clinical outcomes

Population:

99,221 patients with fee-for-services Medicare who underwent endovascular revascularisation within 6 months of CLTI diagnosis

Endpoints:

All-cause death and/or major lower extremity amputation in the 1 year after lower extremity revascularization

Outcomes and conclusion:

A delay of > 30 days from CLTI diagnosis to outpatient lower extremity endovascular revascularisation was associated with an increased risk of major lower extremity amputation.
Compared with CLTI patients who did not undergo out- patient endovascular revascularization, patients who underwent outpatient revascularization were younger (74.9 versus 75.4years), less often Black individuals (13.4% versus 14.8%), and less often women (44.4% versus 48.7%); they had a higher prevalence of heart failure, obesity, and depression, but similar prevalence of diabetes, hypertension, and chronic kidney disease.

Comments:

Improving systems of care for patients with CLTI to improve access to more rapid revascularization may reduce major amputation risk, improving quality of life and functional status in this high-risk cohort.
Sensitivity analysis showed a significant association between D2L time and amputation risk en D2L time was as low as ≥ 16 days
Patients undergoing revascularization < 30 days after diag may be either low comorbidities patients or high risk of amputation patients
Amputation may be underconsidered in public health. Developping a patient-centered process metric for CLTI care is essential.
Patients with CLTI are often older, members of histori- cally marginalized racial and ethnic groups, or have low socioeconomic status