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Younger patients with chronic limb threatening ischemia face more frequent amputations

E Hope Weissler1, Cassie B Ford2, Manesh R Patel3

  • 1Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC.

American Heart Journal
|August 9, 2021
PubMed

Insights

Younger patients with chronic limb threatening ischemia (CLTI) experience worse outcomes, including higher amputation rates. Aggressive risk factor management and inclusion in research are crucial for this demographic.

Area of Science:

  • Vascular Surgery
  • Epidemiology
  • Health Services Research

Background:

  • Chronic limb-threatening ischemia (CLTI) research often excludes younger patients (<65 years) due to dataset limitations.
  • Younger CLTI patients may face higher personal and societal costs, yet their outcomes are understudied.

Purpose of the Study:

  • To characterize and compare outcomes between younger (<65 years) and older patients diagnosed with CLTI.
  • To evaluate the impact of age on major adverse limb events (MALE) and amputation risk in a commercially insured population.

Main Methods:

  • Retrospective cohort study utilizing the MarketScan commercial claims database (July 2014 - December 2017).
  • Identified patients with CLTI, defining primary outcome as MALE and secondary outcomes including amputations and cardiovascular events.
  • Compared demographic and comorbidity profiles, and adverse outcomes between younger (<65) and older (≥65) CLTI patient groups.

Main Results:

  • The cohort comprised 64,663 CLTI patients; 39.6% were <65 years old.
  • Younger patients had higher rates of diabetes mellitus, major adverse limb events (MALE) (31.7% vs. 30.2%), and amputations (11.5% vs. 9.3%).
  • Adjusted analysis revealed age <65 was associated with a 24% increased risk of amputation and a 10% increased risk of MALE.

Conclusions:

  • A substantial proportion of commercially insured CLTI patients are under 65, presenting with poorer limb-related outcomes.
  • Findings underscore the need for aggressive management of atherosclerosis risk factors in younger individuals.
  • Future CLTI research should intentionally include younger populations to improve understanding and treatment strategies.
Abstract

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