Girotra Saket, Li Qiang, Vaughan-Sarrazin Mary, Lund Brian C, Al-Garadi Mohammad, Beckman Joshua A, Nathani Rohit, Hoffman Richard M, Chan Paul S, Banerjee Subhash, Tsai Shirling, Kumbhani Dharam J, Minniefield-Young Nicole, Smolderen Kim G, Arya Shipra, Nguyen Cathy, Matheny Michael E, Gobbel Glenn T
University of Texas Southwestern Medical Center, Dallas, TX.
North Texas Veterans Affairs Medical Center, Dallas, TX.
medRxiv. 2024 Aug 21:2024.08.20.24312328. doi: 10.1101/2024.08.20.24312328.
Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify PAD patients in electronic health records.
METHODS & RESULTS: Leveraging a novel natural language processing (NLP) system that identifies PAD with high accuracy using ankle brachial index (ABI) and toe-brachial index (TBI) values, we created a registry of 103,748 patients with new onset PAD patients in the Veterans Health Administration (VHA). Study endpoints include mortality, cardiovascular (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using VA and non-VA encounters. The mean age was 70.6 years; 97.3% were males, and 18.5% self-identified as Black race. The mean ABI value was 0.78 (SD: 0.26) and the mean TBI value was 0.51 (SD: 0.19). Nearly one-third (32.4%) patients were currently smoking and 35.4% formerly smoked. Prevalence of hypertension (86.6%), heart failure (22.7%), diabetes (54.8%), renal failure (23.6%), and chronic obstructive pulmonary disease (35.4%) was high. At 1-year, 9.4% of patients had died. The 1-year incidence of cardiovascular events was 5.6 per 100 patient-years and limb events was 4.5 per 100 patient-years.
We have successfully launched a registry of >100,000 patients with a new diagnosis of PAD in the VHA, the largest integrated health system in the U.S. The ncidence of death and clinical events in our cohort is high. Ongoing studies will yield important insights regarding improving care and outcomes in this high-risk group.
由于缺乏全国性登记系统以及电子健康记录中用于识别外周动脉疾病（PAD）患者的诊断编码准确性较低，目前关于外周动脉疾病的研究仍然有限。
利用一种新型自然语言处理（NLP）系统，该系统通过踝臂指数（ABI）和趾臂指数（TBI）值高精度识别PAD，我们在美国退伍军人健康管理局（VHA）创建了一个包含103,748例新发PAD患者的登记系统。研究终点包括死亡率、心血管事件（急性心肌梗死或中风住院）和肢体事件（严重肢体缺血或大截肢住院），并通过退伍军人事务部（VA）和非VA就诊记录进行识别。患者的平均年龄为70.6岁；97.3%为男性，18.5%自我认定为黑人种族。平均ABI值为0.78（标准差：0.26），平均TBI值为0.51（标准差：0.19）。近三分之一（32.4%）的患者目前吸烟，35.4%的患者既往吸烟。高血压（86.6%）、心力衰竭（22.7%）、糖尿病（54.8%）、肾衰竭（23.6%）和慢性阻塞性肺疾病（35.4%）的患病率较高。1年后，9.4%的患者死亡。心血管事件的1年发病率为每100患者年5.6例，肢体事件的1年发病率为每100患者年4.5例。
我们已成功在美国最大的综合医疗系统VHA中建立了一个超过100,000例新诊断PAD患者的登记系统。我们队列中的死亡和临床事件发生率较高。正在进行的研究将为改善这一高危人群的护理和结局提供重要见解。
