Impact of a national guideline for the management of peripheral arterial disease on revascularization rates in England: interrupted time series analysis.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae115
Ravi Maheswaran, Thaison Tong, Jonathan Michaels, Paul Brindley, Stephen Walters, Shah Nawaz
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Abstract

Background: A national guideline on peripheral arterial disease management in England was issued in August 2012. The impact on revascularization rates was examined and variation with socioeconomic deprivation assessed.

Methods: Annual hospital admissions for England over 10 years (2008-2009 to 2017-2018) were examined using interrupted time series analysis. A pragmatic approach was used to classify admissions for revascularization into moderate and severe categories.

Results: There were 309 839 admissions (56% for moderate peripheral arterial disease), with an overall annual admission rate for revascularization of 86 per 100 000 population aged 25+ years. The rate for moderate peripheral arterial disease marginally increased by 0.29 per 100 000 per year (95% c.i. -0.22 to 0.80) from 2008-2009 to 2012-2013. Following guideline introduction, this rate decreased. The equivalent for severe peripheral arterial disease increased by 1.33 per 100 000 (0.78 to 1.88). Following guideline introduction, this rate plateaued. The change in rate (slope) for moderate peripheral arterial disease of -2.81 per 100 000 per year (-3.52 to -2.10) after guideline introduction was greater than the change in rate for severe peripheral arterial disease of -1.95 per 100 000 per year (-2.73 to -1.17). For moderate peripheral arterial disease, the annual rate in the most socioeconomically deprived category was 15.6 per 100 000 lower in 2017-2018 compared with 2012-2013 (24.3% decrease). The impact progressively diminished with decreasing deprivation. In the least deprived category, the reduction was 5.2 per 100 000 (12.9% decrease). For severe peripheral arterial disease, the decrease was 1.2 per 100 000 (3.1% reduction) with no consistent variation in relation to deprivation.

Conclusion: Introduction of the national peripheral arterial disease management guideline in England was associated with a reduction in admission rates for revascularization, especially for moderate peripheral arterial disease, with greater reduction in rates for moderate peripheral arterial disease in more socioeconomically deprived areas. Association, however, does not necessarily imply causation and alternative explanations cannot be ruled out.

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国家外周动脉疾病管理指南对英格兰血管再通率的影响:间断时间序列分析。
背景:英国于 2012 年 8 月发布了国家外周动脉疾病管理指南。研究了该指南对血管再通率的影响,并评估了社会经济贫困程度的变化:方法:采用间断时间序列分析法对英格兰 10 年内(2008-2009 年至 2017-2018 年)的年度入院情况进行了研究。采用务实的方法将因血管再通而入院的患者分为中度和重度两类:入院治疗的人数为309 839人(56%为中度外周动脉疾病),每10万名25岁以上人口中,每年接受血管重建治疗的总人数为86人。从2008-2009年到2012-2013年,中度外周动脉疾病的入院率每年每10万人微增0.29(95% c.i.-0.22至0.80)。指南出台后,这一比例有所下降。严重外周动脉疾病的相应比例增加了 1.33/100,000(0.78 至 1.88)。指南出台后,这一比例趋于稳定。指南出台后,中度外周动脉疾病的发病率变化(斜率)为每年每 10 万人-2.81 例(-3.52 至-2.10),大于重度外周动脉疾病的发病率变化(每年每 10 万人-1.95 例(-2.73 至-1.17))。就中度外周动脉疾病而言,与2012-2013年相比,2017-2018年社会经济最贫困类别的年发病率降低了15.6/10万(降幅为24.3%)。随着贫困程度的降低,影响逐渐减弱。在最贫困类别中,每 10 万人减少了 5.2 人(减少了 12.9%)。在严重外周动脉疾病方面,每十万人中减少了1.2人(减少了3.1%),与贫困程度无关:结论:英格兰国家外周动脉疾病管理指南的出台与血管重建入院率的下降有关,尤其是中度外周动脉疾病,在社会经济较为贫困的地区,中度外周动脉疾病入院率的下降幅度更大。然而,关联并不一定意味着因果关系,也不能排除其他解释。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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