Vascular Medicine最新文献

Introduction: Reintervention following peripheral vascular intervention (PVI) for peripheral artery disease (PAD) is common. Guideline-directed medical therapy (GDMT) is recommended post-PVI, yet its association with reintervention outcomes remains unclear.

Methods: We analyzed Vascular Quality Initiative registry data linked with Medicare outcome for patients undergoing PVI for PAD (2017-2018). GDMT was defined as the receipt of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker (ACE/ARB) therapy if hypertensive at discharge. Competing risk analyses and conditional risk models assessed the reintervention outcome, and the recurrent reintervention outcomes within 2 years, by GDMT receipt, compliance with each GDMT element, the number of elements received, and GDMT rate across sites and operators in a 1:1 propensity score-matched cohort.

Results: We included 13,244 patients (mean age 72.0 ± 9.9, women 41.0%). The reintervention outcome did not differ by GDMT receipt (cumulative incidence: 43.0% [95% CI 41.0-44.9%] in no GDMT vs 41.2% [95% CI 39.4- 43.0%] in GDMT; subhazard ratio (sHR): 1.03 [95% CI 0.97-1.10]), compliance with GDMT elements, the number of elements received, or site and operator GDMT rates (sHR per 10% increase: 1.00 [95% CI 0.98-1.03] and 1.00 [95% CI 0.98-1.02]) (all p > 0.05). However, a higher operator GDMT rate reduced the recurrent reintervention risk (HR: 0.98 [95% CI 0.97-1.00], p = 0.026).

Conclusion: Around 40% of patients undergoing a PVI experience reintervention within 2 years, but the outcome was not reduced with GDMT receipt, and higher GDMT rates by site and operators were not associated with reintervention risk. Future studies should focus on medication adherence, refills, and more granular GDMT data for PAD care surveillance postrevascularization.

Billing data including International Classification of Diseases (ICD) codes are increasingly used to identify cohorts of patients with peripheral artery disease (PAD) in electronic health records (EHRs) and administrative claims databases (ACDs). However, the validity of common PAD phenotyping approaches is a central challenge to the utilization of EHR and ACD data. We present a scoping review of contemporary PAD observational studies to describe the electronic phenotyping strategies employed in PAD identification and propose recommendations for improvement. We searched two databases, MEDLINE and Web of Science, identifying a total of 748 articles that underwent title and abstract review. Of these articles, 163 met the criteria for full-text review, with 84 articles ultimately included in the study. We demonstrate that 19.0% of eligible studies utilized ICD, Ninth Revision (ICD-9) codes, 11.9% utilized ICD, Tenth Revision (ICD-10) codes, and 69.0% of studies utilized a combination of ICD-9 and ICD-10 codes in their electronic phenotyping methodology. Of the included studies, 76.2% utilized a single-code query approach for electronic phenotyping despite low diagnostic yield, and 21.4% utilized rule-based methods. Only five studies utilized logistic regression modeling, despite the demonstrated effectiveness of this method. The current study demonstrates high utilization of unreliable electronic phenotyping methods such as single-code-based queries, which severely limits research quality. Improvements in electronic phenotyping methods are necessary to leverage data from EHRs and ACDs for high-quality research.

Lower-extremity peripheral artery disease (PAD) affects approximately 236 million people worldwide and at least eight million people in the United States (US). Despite availability of new therapies that prevent major adverse cardiovascular events (MACE), these and major adverse limb events (MALE) remain common and occur more frequently in people with PAD, either with or without coronary artery disease (CAD), compared to people with CAD who do not have PAD. The most effective therapies to prevent cardiovascular events are not identical in people with PAD and those with CAD. Walking impairment and the risk of lower-extremity amputation are significantly greater in people with PAD compared to those without PAD. This report from the Society for Vascular Medicine (SVM) proposes and summarizes high-priority topics for scientific investigation in PAD, with the goal of improving health outcomes in people with PAD. To develop this report, a multidisciplinary team of scientists and clinicians reviewed literature, proposed high-priority topics for scientific investigation, and voted to rank the highest priority topics for scientific investigation. Priorities for clinical scientific investigation include: determine the current prevalence of PAD in the US by age, sex, race, and ethnicity; improve methods to diagnose PAD; develop new medical therapies to eliminate walking impairment; and improve implementation of established therapies to reduce rates of MACE and MALE in people with PAD. Priorities in basic science and translational science investigation include: developing animal models that closely resemble the vascular, skeletal muscle, and platelet pathology in patients with PAD and defining the genetic and epigenetic contributors to PAD and PAD-associated outcomes. Successful investigation of these research priorities will require more well-trained investigators focused on scientific investigation of PAD, greater and more efficient enrollment of diverse patients with PAD in randomized clinical trials, and increased research funding dedicated to PAD.