Process of Care and Outcomes in Patients with Peripheral Arterial Disease
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We investigated the association of process of care measures with adverse limb and systemic events in patients with peripheral arterial disease (PAD).
We conducted a retrospective cohort study of patients with PAD, as defined by an ankle-brachial index (ABI) <0.9. The index date was defined as the date, during 1995 to 1998, when the patient was seen in the Michael E. DeBakey VA Medical Center noninvasive vascular laboratory and found to have PAD. We conducted a chart review for process of care variables starting 3 years before the index date and ending at the time of the first event or the final visit (December 31, 2001), whichever occurred first. We examined the association between PAD process of care measures, including risk factor control, and prescribing of medication, with time of the patient’s first major limb event or death.
Of the 796 patients (mean age, 65 ± 9.9 years), 230 (28.9% experienced an adverse limb event (136 lower-extremity bypass, 94 lower-extremity amputation), and 354 (44.5%) died. Of the patients who died, 247 died without a preceding limb event. Glucose control was protective against death or a limb event with a hazard ratio (HR) of 0.74 (95% confidence limits [CL] 0.60, 0.91, P = 0.004). African Americans were at 2.8 (95% CL 1.7, 4.5) times the risk of Whites or Hispanics for an adverse limb event. However, this risk was no longer significant if their glucose was controlled. For process measures, the dispensing of PAD specific medication (HR 1.4, 95% CL 1.1, 1.7) was associated an increased risk for an adverse outcome.
Our data suggest that glucose control is key to reducing the risk for adverse outcomes, particularly limb events in African Americans. Certain process of care measures, as markers of disease severity and disease management, are associated with poor outcomes in patients with PAD. Further work is needed to determine the role of early disease intervention to reduce poor outcomes in patients with PAD.
- Process of Care and Outcomes in Patients with Peripheral Arterial Disease
Journal of General Internal Medicine
Volume 22, Issue 7 , pp 942-948
- Cover Date
- Print ISSN
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- peripheral arterial disease
- process of care
- glucose control
- atherosclerosis risk factors
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Division of General Internal Medicine, The University of Minnesota, 420 Delaware St., S.E. MMC 451, Minneapolis, Minnesota, USA
- 2. Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- 3. Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
- 4. Department of Aging and Geriatrics, North Florida/South Georgia Veterans Health System, Rehabilitation and Outcomes Research Center, Geriatric Research, Education and Clinical Center, The University of Florida, Gainesville, Florida, USA
- 5. Minneapolis VA Medical Center, Center for Chronic Disease Outcomes Research, University of Minnesota, Minneapolis, Minnesota, USA
- 6. MD Anderson Cancer Center, University of Texas, Houston, TX, USA
- 7. Department of Surgery, Texas A&M University Health Sciences Center, Temple, TX, USA
- 8. Department of Epidemiology and Community Health, University of Minnesota School of Public Health and the Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- 9. Professor of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA