The association of depression with mortality and major adverse limb event outcomes in patients with peripheral artery disease: A systematic review and meta-analysis

Scierka, Lindsey; Mena‐Hurtado, Carlos; Ahmed, Zain; Yousef, Sameh; Arham, Ahmad Firdhaus; Grimshaw, Alyssa; Harris, Kristie M.; Burg, Matthew M.; Vriens, Patrick W.; Heyligers, Jan M.M.; Lee, Megan; Yazgan, Idil; Smolderen, Kim G.

doi:10.1016/j.jad.2022.09.098

Cited by 10 publications

(5 citation statements)

References 57 publications

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“…7 However, it is notable that nontraditional risk factors such as pain syndromes, anxiety, and depression rank as more important predictors of mortality than many classic risk factors. Despite high rates of behavioral health comorbidities and drastically worse outcomes associated with concomitant behavioral health disease, 34 patients with peripheral artery disease (PAD) are not frequently evaluated for anxiety, depression, or pain syndromes. This represents a lost opportunity—results from this study not only advocate for routine screening for behavioral health comorbidities, but also for establishing interdisciplinary PAD-care teams including behavioral health professionals to mitigate risk.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia

Cleman,

Romain,

Callegari

et al. 2024

Vasc Med

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Introduction: Patients with chronic limb-threatening ischemia (CLTI) have high mortality rates after revascularization. Risk stratification for short-term outcomes is challenging. We aimed to develop machine-learning models to rank predictive variables for 30-day and 90-day all-cause mortality after peripheral vascular intervention (PVI). Methods: Patients undergoing PVI for CLTI in the Medicare-linked Vascular Quality Initiative were included. Sixty-six preprocedural variables were included. Random survival forest (RSF) models were constructed for 30-day and 90-day all-cause mortality in the training sample and evaluated in the testing sample. Predictive variables were ranked based on the frequency that they caused branch splitting nearest the root node by importance-weighted relative importance plots. Model performance was assessed by the Brier score, continuous ranked probability score, out-of-bag error rate, and Harrell’s C-index. Results: A total of 10,114 patients were included. The crude mortality rate was 4.4% at 30 days and 10.6% at 90 days. RSF models commonly identified stage 5 chronic kidney disease (CKD), dementia, congestive heart failure (CHF), age, urgent procedures, and need for assisted care as the most predictive variables. For both models, eight of the top 10 variables were either medical comorbidities or functional status variables. Models showed good discrimination (C-statistic 0.72 and 0.73) and calibration (Brier score 0.03 and 0.10). Conclusion: RSF models for 30-day and 90-day all-cause mortality commonly identified CKD, dementia, CHF, need for assisted care at home, urgent procedures, and age as the most predictive variables as critical factors in CLTI. Results may help guide individualized risk-benefit treatment conversations regarding PVI.

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Section: Discussionmentioning

confidence: 99%

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia

Cleman,

Romain,

Callegari

et al. 2024

Vasc Med

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, data revealed that the highest major amputation rate was in patients with both OUD and MDD, followed by those having only OUD and No MDD. Though a significant number of studies have linked MDD to amputations, [37][38][39] the association between OUD and amputations has been explored in a smaller number of studies and warrants further in-depth research. 40 PAD is a chronic disease, with one of its most prominent manifestations being significant pain, especially in the advanced stages of the disease, and associated functional limitations.…”

Section: Discussionmentioning

confidence: 99%

Impact of comorbid opioid use disorder and major depressive disorder on healthcare utilization outcomes in patients with peripheral artery disease: A National Readmission Database analysis

Amenyedor,

Lee,

Algara

et al. 2024

Vasc Med

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Background: Prior research has demonstrated that individuals with peripheral artery disease (PAD) often have comorbid opioid use disorder (OUD) and major depressive disorder (MDD), with limited data regarding their impact on readmission outcomes, length of stay, and cost. This study aimed to investigate these healthcare utilization outcomes in patients with PAD who have comorbid OUD and MDD. Methods: Data were obtained from the National Readmission Database from 2011 through 2018. The study population included all hospitalizations with PAD as the primary or secondary diagnosis, from which hospitalizations with OUD and MDD were extracted using appropriate ICD-9/10 diagnosis codes. Primary outcomes were 30-day and 90-day readmission, total cost, and total length of stay within the calendar year. We created hierarchical multivariable logistic regression models examining OUD with and without MDD, with a random effect for healthcare facility location. Results: From 2011 to 2018, 13,265,817 weighted admissions with PAD were identified. These admissions were segmented into four categories: No OUD/No MDD (12,056,466), OUD/No MDD (323,762), No OUD/MDD (867,641), and OUD/MDD (17,948). The group with No OUD/No MDD was used as the reference group for all subsequent comparisons. Regarding 30-day and 90-day readmissions, patients with OUD/MDD had odds of 1.14 (95% CI 1.10, 1.18) and 1.09 (95% CI 1.06, 1.13), respectively. Patients with OUD/No MDD bore the highest median cost of $64,354 (IQR $30,797–137,074), and patients with OUD/MDD marked the lengthiest median stay of 6.01 days (IQR 2.01–13.30). Conclusion: This study found a significant association between these comorbidities and outcomes and therefore calls for targeted interventions and pain management strategies.

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“…This comorbidity has been found to augment the risk of adverse limb consequences, notably intermittent claudication, by 20%; at the same time, these patients are accompanied by more complications such as chest pain and palpitations ( 127 , 128 ). In addition, PAD patients afflicted with depression are characterized by heightened risks of amputation and mortality, decreased walking function and a lower quality of life ( 29 , 128 – 130 ). A nationwide observational study covering 155,647 retired military personnel with PAD revealed that patients suffering from coexisting depression heightened the risk of amputation by 13% and the risk of mortality by 17% in contrast to their counterparts without any comorbid depression ( 131 ).…”

Section: Relationship Between Specific Macrovascular Disease and Depr...mentioning

confidence: 99%

Association between depression and macrovascular disease: a mini review

2023

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Depression and macrovascular diseases are globally recognized as significant disorders that pose a substantial socioeconomic burden because of their associated disability and mortality. In addition, comorbidities between depression and macrovascular diseases have been widely reported in clinical settings. Patients afflicted with coronary artery disease, cerebrovascular disease or peripheral artery disease exhibit an elevated propensity for depressive symptoms. These symptoms, in turn, augment the risk of macrovascular diseases, thereby reflecting a bidirectional relationship. This review examines the physiological and pathological mechanisms behind comorbidity while also examining the intricate connection between depression and macrovascular diseases. The present mechanisms are significantly impacted by atypical activity in the hypothalamic–pituitary–adrenal axis. Elevated levels of cortisol and other hormones may disrupt normal endothelial cell function, resulting in vascular narrowing. At the same time, proinflammatory cytokines like interleukin-1 and C-reactive protein have been shown to disrupt the normal function of neurons and microglia by affecting blood–brain barrier permeability in the brain, exacerbating depressive symptoms. In addition, platelet hyperactivation or aggregation, endothelial dysfunction, and autonomic nervous system dysfunction are important comorbidity mechanisms. Collectively, these mechanisms provide a plausible physiological basis for the interplay between these two diseases. Interdisciplinary collaboration is crucial for future research aiming to reveal the pathogenesis of comorbidity and develop customised prevention and treatment strategies.

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The association of depression with mortality and major adverse limb event outcomes in patients with peripheral artery disease: A systematic review and meta-analysis

Cited by 10 publications

References 57 publications

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia

Evaluation of short-term mortality in patients with Medicare undergoing endovascular interventions for chronic limb-threatening ischemia

Impact of comorbid opioid use disorder and major depressive disorder on healthcare utilization outcomes in patients with peripheral artery disease: A National Readmission Database analysis

Association between depression and macrovascular disease: a mini review

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