In the Journals

Patient outcomes after revascularization improve in UK

From 2006 to 2015, overall survival increased and the risk for lower-limb amputation decreased after revascularization in patients with peripheral artery disease in the United Kingdom, researchers reported in Circulation.

“The availability of revascularization procedures has changed during the past decade (2006-2015), and with recent developments in endovascular and surgical technology, particularly stents and drug-eluting technologies, less invasive procedures have become more widely used in the United Kingdom and elsewhere,” Katriina Heikkila, PhD, from the London School of Hygiene and Tropical Medicine, and colleagues wrote. “However, the impact of the increased availability and diversification of procedures on patient outcomes, such as lower-limb amputation and death, is unclear.”

Using individual-patient records from Hospital Episode Statistics, the researchers identified 103,934 patients who underwent endovascular or surgical lower-limb revascularization for infrainguinal PAD in England from 2006 to 2015. They also obtained data on amputations and deaths within 1 year after revascularization using Hospital Episode Statistics and the Office for National Statistics mortality records.

During the study period, results showed significant reductions in the estimated 1-year risk for major amputation after both types of revascularization, according to the data. Specifically, from 2006 to 2015, the estimated 1-year risk for major amputation decreased from 5.7% to 3.9% after endovascular revascularization (P < .0001) and from 11.2% to 6.6% after surgery (P < .0001).

Additionally, from 2006 to 2015, the estimated 1-year risk for death decreased from 9.5% to 6% after endovascular procedures and from 11.1% to 6.4% after surgery (P < .0001), according to the data.

Similar downward trends in amputation risk were found across indications categories. The most pronounced reduction in risk, however, was noted in patients with severe limb ischemia with ulceration or gangrene.

Of the patients included in the study, most were men aged at least 65 years. The proportion of men undergoing revascularization increased slightly during the study period, as did the proportion of patients with Royal College of Surgeons Charlson scores 2 and 3, the proportion of patients undergoing revascularization for severe limb ischemia and the prevalence of diabetes. Endovascular procedures also became more common, whereas surgical revascularization became less common, during the study period.

The researchers cited several potential explanations for the reductions in amputation risk and mortality during the study period. These included new technologies and techniques that may improve outcomes, reorganization of vascular surgical care in the United Kingdom, improvements in CV care and an overall decline in CVD, and changes in diagnostic coding. However, the evidence is not yet strong enough to attribute the improved outcomes after revascularization to any one factor, they noted.

Nevertheless, the increased survival and decreased amputation risk, despite the greater morbidity and severity of disease of the patients undergoing revascularization, is encouraging, according to the researchers.

“Our findings seem reassuring in that, coinciding with the reconfiguration of vascular services in the United Kingdom, patient outcomes following infrainguinal revascularization seem to have improved,” Heikkila told Cardiology Today’s Intervention. “However, variation in the outcomes of care associated with PAD is still only partly understood and merits future research.” – by Melissa Foster

For more information:

Katriina Heikkila, PhD, can be reached at London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom; email: katriina.heikkila@lshtm.ac.uk.

Disclosures: The authors report no relevant financial disclosures.

Editor’s note: This article was updated on Jan. 30 with quotes from Dr. Heikkila.

From 2006 to 2015, overall survival increased and the risk for lower-limb amputation decreased after revascularization in patients with peripheral artery disease in the United Kingdom, researchers reported in Circulation.

“The availability of revascularization procedures has changed during the past decade (2006-2015), and with recent developments in endovascular and surgical technology, particularly stents and drug-eluting technologies, less invasive procedures have become more widely used in the United Kingdom and elsewhere,” Katriina Heikkila, PhD, from the London School of Hygiene and Tropical Medicine, and colleagues wrote. “However, the impact of the increased availability and diversification of procedures on patient outcomes, such as lower-limb amputation and death, is unclear.”

Using individual-patient records from Hospital Episode Statistics, the researchers identified 103,934 patients who underwent endovascular or surgical lower-limb revascularization for infrainguinal PAD in England from 2006 to 2015. They also obtained data on amputations and deaths within 1 year after revascularization using Hospital Episode Statistics and the Office for National Statistics mortality records.

During the study period, results showed significant reductions in the estimated 1-year risk for major amputation after both types of revascularization, according to the data. Specifically, from 2006 to 2015, the estimated 1-year risk for major amputation decreased from 5.7% to 3.9% after endovascular revascularization (P < .0001) and from 11.2% to 6.6% after surgery (P < .0001).

Additionally, from 2006 to 2015, the estimated 1-year risk for death decreased from 9.5% to 6% after endovascular procedures and from 11.1% to 6.4% after surgery (P < .0001), according to the data.

Similar downward trends in amputation risk were found across indications categories. The most pronounced reduction in risk, however, was noted in patients with severe limb ischemia with ulceration or gangrene.

Of the patients included in the study, most were men aged at least 65 years. The proportion of men undergoing revascularization increased slightly during the study period, as did the proportion of patients with Royal College of Surgeons Charlson scores 2 and 3, the proportion of patients undergoing revascularization for severe limb ischemia and the prevalence of diabetes. Endovascular procedures also became more common, whereas surgical revascularization became less common, during the study period.

The researchers cited several potential explanations for the reductions in amputation risk and mortality during the study period. These included new technologies and techniques that may improve outcomes, reorganization of vascular surgical care in the United Kingdom, improvements in CV care and an overall decline in CVD, and changes in diagnostic coding. However, the evidence is not yet strong enough to attribute the improved outcomes after revascularization to any one factor, they noted.

Nevertheless, the increased survival and decreased amputation risk, despite the greater morbidity and severity of disease of the patients undergoing revascularization, is encouraging, according to the researchers.

“Our findings seem reassuring in that, coinciding with the reconfiguration of vascular services in the United Kingdom, patient outcomes following infrainguinal revascularization seem to have improved,” Heikkila told Cardiology Today’s Intervention. “However, variation in the outcomes of care associated with PAD is still only partly understood and merits future research.” – by Melissa Foster

For more information:

Katriina Heikkila, PhD, can be reached at London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom; email: katriina.heikkila@lshtm.ac.uk.

Disclosures: The authors report no relevant financial disclosures.

Editor’s note: This article was updated on Jan. 30 with quotes from Dr. Heikkila.