Illness trajectories after revascularisation in patients with PAD: a unified approach to understanding the risk of major amputation and death

Selected in Circulation by Mathis Bodin

This study is a retrospective cohort analysis examining illness trajectories and outcomes, including major amputation and mortality, in patients aged 50 and older who underwent lower limb revasculasization for peripheral artery disease in England. The research highlights variations in patient outcomes based on age, admission type, and PAD severity.

References:

Authors: Qiuju Li, Panagiota Birmpili, Eleanor Atkins, Amundeep S. Johal, Sam Waton, Robin Williams, Jonathan R. Boyle, Denis W. Harkin, Arun D. Pherwani, and David A. Cromwell

Reference: Qiuju Li et Al. CIRCULATION.2024 DOI: 10.1161/CIRCULATIONAHA.123.067687

DOI: 10.1161/CIRCULATIONAHA.123.067687

Read the abstract

Objective:

The objective was to describe the illness trajectories after revascularisation for patients with lower limb Peripheral Artery Disease (PAD) and to investigate the subsequent patterns of major amputation and mortality.

Study:

Retrospective cohort study based on a data set extracted from the Hospital Episode Statistics Admitted Patient Care database for England and the UK Office for for National Statistics Death Registry.

Population:

Patients aged of 50 years old or more and who underwent lower limb revascularization with PAD at NFS hospitals in England.

Endpoint:

There were four primary endpoints : the cumulative incidence of major amputation, of death without major amputation, of death after major amputation and of overall death at the end of the study.

Outcomes and conclusion:

This retrospective cohort highlights the variation of trajectories experienced by patients depending of theirs caracteristics and subgroups. The most important elements seems to be the age, the admission type and the severity of PAD.

Source: Circulation

Comments:

The study underscores the importance of understanding disease progression in patients with peripheral artery disease (PAD) following lower limb revascularisation. Key considerations include:

Patient Characteristics:

Emergency vs. Elective Treatment:

Patients presenting with critical limb ischemia often require urgent intervention. However, current classification systems may have limitations, necessitating tailored treatment approaches.

Age:

Older patients may have different disease trajectories, influenced by factors such as comorbidities and end-of-life considerations.

Timing between revascularisation and amputation:

Understanding the interval between procedures can inform treatment adjustments and help identify patients at higher risk for adverse outcomes.

Study limitations:

Multiple Revascularisations:

The impact of repeated procedures on patient outcomes requires further investigation.

ICD-10 coding precision:

Potential inaccuracies in coding may affect data reliability.

Lack of detailed disease localisation:

Absence of precise information on PAD location could influence the applicability of findings.