Frequency of Care and Mortality Following an Incident Diagnosis of Peripheral Artery Disease in the Inpatient or Outpatient Setting: The ARIC (Atherosclerosis Risk in Communities) Study

Abstract

BackgroundAvailable health services data for individuals with peripheral artery disease (PAD) are often from studies of those eligible for or undergoing intervention. Knowledge of the frequency of care and mortality following an initial PAD diagnosis by setting (outpatient versus inpatient) is limited and represents an opportunity to provide new benchmark information.Methods and ResultsThe purpose of this study was to characterize the frequency of care and mortality following an incident PAD diagnosis in the outpatient or inpatient setting using data from the ARIC (Atherosclerosis Risk in Communities) study cohort linked with Centers for Medicare and Medicaid Services fee‐for‐service claims data (2002–2012). Direct standardization was used to estimate age‐standardized rates of encounters and mortality. PAD was defined by billing code in any claim position. We observed 1086 incident PAD cases (873 outpatient, 213 inpatient). At 1 year after diagnosis, participants diagnosed in the outpatient setting had 2.15 (95% confidence interval [CI], 2.10–2.21) PAD‐related outpatient encounters per person‐year, and 6.4% (95% CI, 4.8–8.1) had a PAD‐related hospitalization. Conversely, participants diagnosed in the inpatient setting had 1.02 (95% CI, 0.94–1.10) PAD‐related outpatient encounters per person‐year, and 14.2% (95% CI, 9.3–18.7) had a PAD‐related rehospitalization. One‐year mortality was 7.1% (95% CI, 5.4–8.7) and 16.0% (95% CI, 11.0–21.1) among those diagnosed in outpatient and inpatient settings, respectively.ConclusionsThis study provides important data estimating frequency of care and mortality by the setting of initial PAD diagnosis. Individuals with PAD are frequent users of health care, and those diagnosed in the inpatient setting have high rates of rehospitalization and mortality.

Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

“…Peripheral artery disease has a well-established high risk of death following diagnosis ( 34 ). Death rates are particularly high among patients diagnosed with PAD in the inpatient setting ( 35 ). Less is known about the racial/ethnic pattern of in-hospital mortality among PAD patients, particularly in patients that are not Black or White.…”

A systematic review of patient-reported outcome measures patients with chronic limb-threatening ischemia

“…Further, PROMs will be needed when treatments are compared across different groups in clinical trials. [20][21][22][23] Finally, the overall impact of systematic treatment of the comorbidities which often occurs concomitantly with CLTI, such as diabetes and smoking, may have small impact at the individual level. However, when examining small changes in QoL using accurate tools, differences may be detectable in large populations if the measures are precise and reproducible.…”

Multiple metabolic comorbidities and their consequences among patients with peripheral arterial disease

“…The finding that low socioeconomic status was associated with increased risk of MACE in PAD patients was consistent with prior studies. Disadvantaged individuals, such as non-white or low-income patients (e.g., Medicaid recipients) have been reported to experience more metabolic comorbidities that aggravated PAD than the socioeconomically advantaged population [ 25 ]. The development of cardiovascular events is also known to be related to some social determinants of health (e.g., income).…”