The association of healthcare disparities and patient-specific factors on clinical outcomes in peripheral artery disease
The association of healthcare disparities and patient-specific factors on clinical outcomes in peripheral artery disease
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DOI：
10.1016/j.ahj.2021.05.014
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发表时间：
2021-06-21
影响因子：
4.8
通讯作者：
Jones, W. Schuyler
中科院分区：
文献类型：
--
作者：
Narcisse, Dennis I.;Ford, Cassie B.;Jones, W. Schuyler
背景PAD增加了心血管死亡和肢体丧失的风险，并且治疗和结局的差异已被描述。然而，患者特异性特征与结局变化的相关性不太为人所知。方法确定了2015年1月1日至2016年3月31日期间来自杜克大学卫生系统（DUHS）的PAD患者。PAD状态通过使用诊断代码、程序代码和其他管理数据的基础事实裁定和预测建模进行确认。从电子健康记录（EHR）中手动提取症状严重程度、下肢成像和踝臂指数（ABI）。数据与医疗保险和医疗补助服务中心的数据相关联，以提供纵向随访。主要结果是主要不良血管事件（MAVE），全因死亡率，心肌梗死（MI），中风，下肢血运重建和amplituds.Results的复合1,768例PAD患者，31.6%是无症状的，41.2%有间歇性跛行（IC），27.3%有慢性肢体缺血（CLTI）。1年时，CLTI患者的MAVE发生率高于无症状或IC患者。CLTI和Medicaid双重资格是死亡率的独立预测因素。结论CLTI患者MAVE发生率最高，但IC或无症状疾病患者的不良事件发生率也较高。黑人和医疗补助双重资格的患者不成比例地出现在CLTI亚组中，并且分别具有较高的截肢和死亡风险。未来的研究必须关注早期识别高危患者群体，以改善PAD患者的结局。
Background PAD increases the risk of cardiovascular mortality and limb loss, and disparities in treatment and outcomes have been described. However, the association of patient-specific characteristics with variation in outcomes is less well known.Methods Patients with PAD from Duke University Health System (DUHS) between January 1, 2015 and March 31, 2016 were identified. PAD status was confirmed through ground truth adjudication and predictive modeling using diagnosis codes, procedure codes, and other administrative data. Symptom severity, lower extremity imaging, and ankle-brachial index (ABI) were manually abstracted from the electronic health record (EHR). Data was linked to Centers for Medicare and Medicaid Services data to provide longitudinal follow up. Primary outcome was major adverse vascular events (MAVE), a composite of all-cause mortality, myocardial infarction (MI), stroke, lower extremity revascularization and amputation.Results Of 1,768 patients with PAD, 31.6% were asymptomatic, 41.2% had intermittent claudication (IC), and 27.3% had chronic limb-threatening ischemia (CLTI). At 1 year, patients with CLTI had higher rates of MAVE compared with asymptomatic or IC patients. CLTI and Medicaid dual eligibility were independent predictors of mortality. CLTI and Black race were associated with amputation.Conclusions Rates of MAVE were highest in patients with CLTI, but patients with IC or asymptomatic disease also had high rates of adverse events. Black and Medicaid dual-eligible patients were disproportionately present in the CLTI subgroup and were at higher risk of amputation and mortality, respectively. Future studies must focus on early identification of high-risk patient groups to improve outcomes in patients with PAD.