Clinical features and prognosis in patients with chronic limb-threatening ischemia receiving welfare in Japan

Abstract

Background:

In patients with chronic limb-threatening ischemia (CLTI), a subset of patients are beneficiaries of welfare assistance. We sought to investigate the clinical features and prognosis of patients with CLTI receiving welfare compared to those not receiving welfare in the Japanese population.

Methods:

This is a subanalysis of the multicenter, prospective Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchemia (WARRIORS) registry. We evaluated 440 patients with CLTI accompanied by tissue loss undergoing infrapopliteal revascularization. The outcome measures included a 24-month wound-healing rate, and overall survival and follow-up continuity. We compared the outcomes between the welfare and nonwelfare groups (n = 48 and 392, respectively) using the Kaplan–Meier method and log-rank tests.

Results:

Frequencies of nonambulatory status, diabetes mellitus, hemodialysis, and wound severity stratified by Wound, Ischemia, and foot Infection classification showed no significant inter-group differences. The number of patients treated with bypass surgery was lower in the welfare group than in the nonwelfare group. The 24-month wound healing and follow-up continuity rates were significantly lower in the welfare group compared to the nonwelfare group (37.3% vs 59.6%, p = 0.005 and 47.9% vs 58.0%, p = 0.048, respectively). In contrast, the 24-month overall survival rate did not differ significantly between the groups (63.1% vs 71.7%, p = 0.27).

Conclusions:

Patients receiving welfare had significantly worse wound-healing rates and a higher loss to follow up even within the framework of the Japanese universal health insurance system.