ArticleJournal of general internal medicine2007
Process of care and outcomes in patients with peripheral arterial disease.
Article in Journal of general internal medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Impact of diabetes on mortality in peripheral artery disease: a meta-analysis.Clinical cardiology · 2017Pooled it
- Perineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results.Journal of anesthesia · 2009Trial
- Article
- High hemoglobin AJournal of vascular surgery · 2018Article
- Association of elevated fasting glucose with lower patency and increased major adverse limb events among patients with diabetes undergoing infrapopliteal balloon angioplasty.Vascular medicine (London, England) · 2014Article
- Proceedings from the Society of Interventional Radiology research consensus panel on critical limb ischemia.Journal of vascular and interventional radiology : JVIR · 2013Article
- The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients.Medical care research and review : MCRR · 2010Review
- Mortality following operations for lower extremity peripheral arterial disease.Vascular health and risk management · 2010Article
- Disparities in vascular surgery: is it biology or environment?Journal of vascular surgery · 2010Review
- Peripheral arterial disease is associated with higher rates of hip bone loss and increased fracture risk in older men.Circulation · 2009Article
Corrections and comments
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Authors and funding
8 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWe investigated the association of process of care measures with adverse limb and systemic events in patients with peripheral arterial disease (PAD).
methodsWe 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.
resultsOf 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.
conclusionsOur 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.
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