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Underutilization of guideline-recommended therapy in patients 80 years and older with peripheral artery diseases

Daniel Messiha1, Olga Petrikhovich1, Julia Lortz1

  • 1Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany.

VASA. Zeitschrift Fur Gefasskrankheiten
|October 23, 2023
PubMed

Insights

Older adults with peripheral artery disease (PAD) receive less guideline-recommended treatment and specialized care. This highlights significant age-related health inequalities in managing PAD, a condition exacerbated by aging.

Area of Science:

  • Cardiovascular Medicine
  • Geriatrics
  • Health Services Research

Background:

  • Aging is a significant cardiovascular risk factor, increasing atherosclerotic burden and mortality, particularly in Peripheral Artery Disease (PAD).
  • Despite guideline-recommended treatments, their implementation in PAD care is often inadequate.
  • Age-related health inequalities in high-risk PAD populations remain under-elucidated on a national scale.

Purpose of the Study:

  • To analyze outpatient treatment structures and guideline adherence for Peripheral Artery Disease (PAD) patients over 80 years old.
  • To investigate age-related differences in the prevalence, pharmacotherapy, and specialized outpatient care of PAD patients.

Main Methods:

  • Analysis of nationwide ambulatory claims data in Germany from 2009 to 2018, covering 70.1 million individuals annually.
  • Inclusion of 17,633,970 PAD patients, with a specific focus on 28% who were over 80 years old.
  • Examination of age-related disparities in PAD prevalence, statin and antiplatelet pharmacotherapy, and access to specialized care (angiology, vascular surgery, cardiology).

Main Results:

  • PAD prevalence increased from 1.85% to 3.14% between 2008 and 2018, with the proportion of patients over 80 increasing by one-third.
  • Octogenarians were undertreated with guideline-recommended statins (46.5% vs. 52.4%) but received antiplatelets more frequently (30.6% vs. 29.3%) compared to younger patients.
  • Patients aged 80 and older had less access to specialized outpatient care, including angiology (6.4% vs. 9.5%), vascular surgery (8.1% vs. 11.8%), and cardiology (25.2% vs. 29.2%).

Conclusions:

  • Significant age-related differences exist in the pharmacotherapy and specialized outpatient care of Peripheral Artery Disease (PAD) patients.
  • Overall guideline-recommended outpatient treatment for PAD is suboptimal, with patients aged 80 and older receiving less evidence-based care.
  • Addressing these age-related health inequalities in PAD management is a critical challenge for future healthcare.

Keywords:
AtherosclerosisCLTIPADdemographicsgeriatricsguidelinesoctogenarians

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