Epidemiology of venous leg ulcers in primary health care: Incidence and prevalence in a health centre—A time series study (2010‐2014)

Abstract

The aims of the study were to describe and analyse the temporal trend of the prevalence and incidence of venous leg ulcers (VLU) over the years 2010 to 2014, to determine healing times and temporal trends in the study period, and to evaluate related aspects such as the use of the Ankle‐Brachial Pressure Index (ABPI) in a primary care health centre. This was a retrospective study based on a time series (years 2010‐2014) of the prevalence and incidence of VLUs in people aged over 40 years in a primary care centre in Barcelona City. We reviewed 3920 electronic health records selecting patients, per year (2010‐2014), with VLUs based on the ICD‐10 diagnoses. For prevalence, we took into account any patient with an active VLU in the year of study. For incidence, we took into account patients with a new VLU in the year of study. A descriptive analysis was carried out based on each of the collected variables. The variables were examined according to the years of study (time series) by one‐factor analysis of variance (anova) or Kruskal–Wallis non‐parametric test, as appropriate. A survival analysis by Kaplan–Meier curves and log‐rank test was also performed. A total of 139 patients met the VLU criteria. Among them, only 79.2% were classified as having a VLU and had a correct ICD diagnosis. The prevalence and incidence increased over the years, doubling in patients aged over 65 years. Incidence increased from 0.5 new cases per 1000 people/year in 2010 to 1 new case for every 1000 people/year in 2014. Moreover, the prevalence ranged between 0.8 and 2.2 patients with VLU for every 1000 people/year. During the study period, a total of 84.2% of the VLUs healed (117/139 VLU). Regarding average annual time to healing, the trend indicates that lesions took less time to heal (Kruskal–Wallis test, P = 0.004), ranging between 453,9 weeks in 2005 to 19 weeks in 2014. The use of ABPI also evolved and was found to be increasingly performed prior to the appearance of the lesion. The epidemiological profile of people affected by VLUs continues to be, mainly, that of women of an advanced age, over 70 years. The frequency of VLU occurrence rose continually over the years, but healing took less time, and use of ABPI improved. Assigning a reference nurse in the wounds unit and the organisational structure around this problem may have an influence on improving care and the approach to these types of lesions.

Long-term Clinical and Cost-effectiveness of Early Endovenous Ablation in Venous Ulceration

“…Venous leg ulceration is the most extreme manifestation of chronic venous disease, and worldwide prevalence is increasing. Compression therapy has been shown to improve ulcer healing, and 1-year outcomes from the Early Venous Reflux Ablation (EVRA) trial revealed that early endovenous ablation of superficial venous reflux (varicose veins) accelerated healing of venous leg ulcers compared with deferred intervention. Early intervention was also shown to be cost-effective in the short term.…”

Translation and cross-cultural adaptation of the Venous Leg Ulcer Self Efficacy Tool for use in a Swiss-French setting

“…A cross-cultural research study in three outpatient clinics in western Switzerland was conducted following 1 translation of the original instrument into Swiss French by two independent translators, 2 construction of a consensus version based on both translations, 3 two independent back translations of the consensus version into English, 4 review by an expert committee and construction of a draft questionnaire, 5 testing of the draft questionnaire on people with a venous leg ulcer and 6 construction of the final questionnaire version.…”

“…The occurrence ranges between 0.8 and 2.2 per 1000 people/year. 1 Healing times of VLUs are long, and up to 70% of the patients suffer a recurrence within three months after wound closure. [2][3][4] These wounds have a negative impact on all aspects of daily life.…”

A prospective pilot study of thigh‐administered intermittent pneumatic compression in the management of hard‐to‐heal lower limb venous and mixed aetiology ulcers

“…Many lower limb ulcers are chronic conditions most commonly caused by venous or arterial insufficiency or a combination of both. The prevalence is approximately 0.16% to 1.42% in the adult population but nearly doubles at 1.69% to 5% in those over 65 years of age . In a retrospective time series study in a primary care centre in Barcelona, the incidences of venous leg ulcers have shown an increasing trend, with the rates doubling over a 4‐year period between 2010 and 2014 .…”

“…The prevalence is approximately 0.16% to 1.42% in the adult population but nearly doubles at 1.69% to 5% in those over 65 years of age . In a retrospective time series study in a primary care centre in Barcelona, the incidences of venous leg ulcers have shown an increasing trend, with the rates doubling over a 4‐year period between 2010 and 2014 . Those with leg ulceration have a significantly poorer quality of life compared with healthy people, with issues such as pain, poor mobility, and negative psychological functioning .…”