National Heart and Lung Institute, Imperial College London, London, UK.
Department of Vascular Medicine - Angiology, Klinikum Darmstadt, Darmstadt, Germany.
Vasc Med. 2022 Oct;27(5):440-449. doi: 10.1177/1358863X221096704. Epub 2022 Jun 7.
Symptoms, severity, and acuteness of peripheral artery disease (PAD) are major determinants of severe limb symptoms, subsequent risk of cardiovascular events, and mortality. Lower-extremity revascularization (LER) is a key option to relieve symptoms and to prevent limb loss in symptomatic patients with PAD. This study aimed to quantify the burden of disease among patients with PAD-LER in England. A retrospective population-based study of linked primary and secondary care electronic health records, included 13,869 adult patients (aged ⩾ 18 years) with PAD-LER from 2003 to 2018. The incidence of first ever PAD-LER was estimated both overall and by type of procedure (endovascular/surgical). Health resource utilization associated with PAD-related complications and treatment patterns were assessed. A high annual incidence of lower-limb revascularization (41.2 per 1000 person years) and a nearly double incidence of endovascular first revascularization compared with open surgery were observed. More than 70% of patients with PAD-LER had a history of hyperlipidemia and hypertension and roughly one-third were diabetic and had a history of coronary artery disease. Cardiovascular mortality accounted for one-third (34.1 per 1000 person years) of all-cause mortality. Over 93% of patients were hospitalized for any reason and the commonest reasons for hospitalization were cardiovascular diseases and PAD with about one-third hospitalized for revascularization reoccurrence. There is a significant burden of PAD-LER to the individual and society with ongoing healthcare resource utilization, treatment, and increasing mortality.
外周动脉疾病(PAD)的症状、严重程度和急性程度是严重肢体症状、随后心血管事件风险和死亡率的主要决定因素。下肢血运重建(LER)是缓解症状和预防有症状 PAD 患者肢体丧失的关键选择。本研究旨在量化英国 PAD-LER 患者的疾病负担。
一项回顾性基于人群的初级和二级保健电子健康记录关联研究,纳入了 2003 年至 2018 年间 13869 名患有 PAD-LER 的成年患者(年龄 ⩾18 岁)。总体上和按手术类型(血管内/手术)分别估计首次 PAD-LER 的发病率。评估了与 PAD 相关并发症和治疗模式相关的卫生资源利用情况。
下肢血运重建的年发病率很高(41.2/1000 人年),与开放手术相比,首次血管内血运重建的发病率几乎翻了一番。超过 70%的 PAD-LER 患者有高脂血症和高血压病史,大约三分之一的患者患有糖尿病且有冠状动脉疾病病史。心血管死亡率占全因死亡率的三分之一(34.1/1000 人年)。超过 93%的患者因任何原因住院,最常见的住院原因是心血管疾病和 PAD,约三分之一的患者因血运重建再发住院。
PAD-LER 对个人和社会造成了重大的疾病负担,持续的医疗保健资源利用、治疗和不断增加的死亡率。