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Published on: September 22, 2020
Risk factor management over two decades in hospitalised patients with chronic limb-threatening ischaemia with and
Sofia Bodinger1, Tove Wikström1, Anders Gottsäter1,2
1Department of Clinical Sciences, Lund University, Malmö, Sweden.
Insights
Chronic limb-threatening ischemia (CLTI) hospitalizations decreased, with improved prognosis due to better medical care. However, secondary prevention for CLTI patients, especially those with diabetes mellitus (DM), requires significant enhancement.
Area of Science:
- Vascular Surgery
- Diabetology
- Public Health
Background:
- Chronic limb-threatening ischemia (CLTI) is a severe condition associated with high amputation and mortality rates.
- Diabetes mellitus (DM) is a significant comorbidity impacting CLTI outcomes.
Purpose of the Study:
- To compare the incidence, management, and prognosis of hospitalized CLTI patients with and without DM between 2001 and 2023.
- To assess adherence to global vascular guidelines for risk factor management in CLTI patients with and without DM in 2023.
Main Methods:
- Retrospective study analyzing data from 2001 and 2023.
- Statistical analysis included Mann-Whitney U test, independent sample t-test, and Chi-square test.
- Multivariable logistic regression evaluated the impact of DM on 1-year mortality.
Main Results:
- CLTI hospitalizations decreased from 37.4 to 22.8 per 100,000 person-years between 2001 and 2023.
- Significant increases in oral anticoagulant and lipid-lowering therapy were observed.
- Diabetes mellitus was independently associated with increased 1-year mortality (OR 1.7), while the 2023 period showed decreased mortality (OR 0.62).
Conclusions:
- Hospitalization rates for CLTI have declined, and patient prognosis has improved, likely due to enhanced medical care.
- Despite improvements, secondary prevention strategies for CLTI patients, particularly those with DM, need substantial enhancement.
- Adherence to risk factor management guidelines, especially for patients with diabetes, remains an area for improvement.
Background:
Chronic limb-threatening ischaemia (CLTI) causes high rates of amputation and mortality.
Objectives:
To compare incidence, management and prognosis in hospitalised patients with CLTI with and without diabetes mellitus (DM) in 2001 and 2023. A secondary objective was to compare adherence to global vascular guidelines on risk factors between patients with and without DM in 2023.
Design:
Retrospective study.
Methods:
Group differences were tested using the Mann-Whitney U test, independent sample t test or the Chi-square test, as appropriate. The effects of DM on major amputation or mortality at 1 year were evaluated in a multivariable logistic regression model according to a directed acyclic graph.
Results:
The incidence of hospitalisations for CLTI was reduced from 37.4 (95% confidence interval (CI), 33.3-41.6) in 2001 to 22.8 (95% CI, 19.7-25.8) per 100,000 person-years in 2023. The proportion of patients on full-dose oral anticoagulant therapy (p < 0.001) and lipid-lowering treatment (p < 0.001) increased significantly between the two time periods. In 2023, Wounds, Ischemia and foot Infection-classification in all patients with foot ulcers was documented in 6.9%. Anaemia was present at hospital admission in 67.0% and 52.5% of patients with CLTI with and without DM, respectively (p = 0.031). Endovascular therapy was performed more often in those with DM compared to those without DM (p = 0.004). Antiplatelet therapy (p = 0.008) and smoking cessation interventions (p = 0.033) were offered less often to those with DM. DM (odds ratio (OR), 1.7 (95% CI, 1.02-2.83)) was independently associated with increased mortality at 1 year, whereas period 2023 as opposed to 2001 (OR, 0.62 (95% CI, 0.38-0.99)) was associated with decreased mortality.
Conclusion:
The incidence of hospitalisation for CLTI appears to have been reduced, and medical care of patients with CLTI has improved prognosis. Nevertheless, there is still room for large improvements of secondary prevention care in patients with CLTI, particularly in those with DM.
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