Mahoney Elizabeth M, Wang Kaijun, Keo Hong H, Duval Sue, Smolderen Kim G, Cohen David J, Steg Gabriel, Bhatt Deepak L, Hirsch Alan T
Saint Luke's Mid America Heart and Vascular Institute, Kansas City, MO, USA.
Circ Cardiovasc Qual Outcomes. 2010 Nov;3(6):642-51. doi: 10.1161/CIRCOUTCOMES.109.930735. Epub 2010 Oct 12.
Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events. The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international prospective registry of patients at risk of atherothrombosis caused by established arterial disease or the presence of ≥3 atherothrombotic risk factors.
We compared the 2-year rates of vascular-related hospitalizations and associated costs in US patients with established PAD across patient subgroups. Symptomatic PAD at enrollment was identified on the basis of current intermittent claudication with an ankle-brachial index (ABI) <0.90 or a history of lower-limb revascularization or amputation. Asymptomatic PAD was diagnosed on the basis of an enrollment ABI <0.90 in the absence of symptoms. Overall, 25 763 of the total 68 236-patient REACH cohort were enrolled from US sites; 2396 (9.3%) had symptomatic and 213 (0.8%) had asymptomatic PAD at baseline. One- and cumulative 2-year follow-up data were available for 2137 (82%) and 1677 (64%) of US REACH patients with either symptomatic or asymptomatic PAD, respectively. At 2 years, mean cumulative hospitalization costs, per patient, were $7445, $7000, $10 430, and $11 693 for patients with asymptomatic PAD, a history of claudication, lower-limb amputation, and revascularization, respectively (P=0.007). A history of peripheral intervention (lower-limb revascularization or amputation) was associated with higher rates of subsequent procedures at both 1 and 2 years.
The economic burden of PAD is high. Recurring hospitalizations and repeat revascularization procedures suggest that neither patients, physicians, nor healthcare systems should assume that a first admission for a lower-extremity PAD procedure serves as a permanent resolution of this costly and debilitating condition.
外周动脉疾病（PAD）很常见，会引发全身性和肢体重大缺血事件的高风险。持续健康动脉粥样硬化血栓形成减少（REACH）注册研究是一项针对因已确诊的动脉疾病或存在≥3个动脉粥样硬化血栓形成风险因素而有动脉粥样硬化血栓形成风险患者的国际前瞻性注册研究。
我们比较了美国已确诊PAD患者不同亚组的2年血管相关住院率及相关费用。入组时的症状性PAD根据当前间歇性跛行且踝臂指数（ABI）<0.90或下肢血运重建或截肢病史来确定。无症状性PAD根据入组时ABI<0.90且无症状来诊断。总体而言，REACH队列中68236例患者中有25763例来自美国研究点；2396例（9.3%）在基线时有症状性PAD，213例（0.8%）有无症状性PAD。美国REACH研究中，分别有2137例（82%）有症状性或无症状性PAD的患者可获得1年和累计2年的随访数据，1677例（64%）可获得累计2年的随访数据。2年时，无症状性PAD、有间歇性跛行病史、下肢截肢和血运重建患者的平均累计住院费用分别为每位患者7445美元、7000美元、10430美元和11693美元（P=0.007）。外周干预史（下肢血运重建或截肢）与1年和2年时后续手术的较高发生率相关。
PAD的经济负担很重。反复住院和重复血运重建手术表明，患者、医生和医疗保健系统都不应认为下肢PAD手术的首次入院能永久性解决这种代价高昂且使人衰弱的疾病。
