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Abstract

Background

Few data are available on risk factors and associations with outcomes in symptomatic peripheral artery disease (PAD) populations in primary care. We assessed characteristics and cardiovascular outcomes in patients with and those without symptomatic peripheral artery disease in UK primary care, and quantified risk factors for cardiovascular outcomes in patients with peripheral artery disease.

Methods

Among patients in The Health Improvement Network (THIN) aged 50–89 years in 2000–2010, a symptomatic peripheral artery disease cohort (n = 28,484) and a matched comparison cohort without peripheral artery disease (n = 113,940) were identified using Read codes. Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular outcomes were calculated, adjusted for potential confounders.

Results

The incidence of all-cause death per 1000 person-years was 83.22 and 50.46 in the peripheral artery disease and non-peripheral artery disease cohort, respectively (HR 1.41; 95% CI 1.68–1.43). The incidence of composite cardiovascular outcome (myocardial infarction, ischaemic stroke or cardiovascular-related death) per 1000 person-years was 31.87 and 14.63 in the peripheral artery disease and non-peripheral artery disease cohort, respectively (HR 1.71; 95% CI 1.65–1.77). Risk factors for composite cardiovascular outcome in patients with peripheral artery disease were older age (≥75 years vs. 50–64 years: HR 2.37; 95% CI 2.20–2.55), current smoking (1.26; 1.17–1.35), comorbid diabetes (1.42; 1.32–1.52), heart failure (1.31; 1.20–1.44), atrial fibrillation (1.32; 1.18–1.47, previous myocardial infarction (1.29; 1.20–1.39) and previous ischaemic stroke (1.77; 1.63–1.93).

Conclusion

Patients with symptomatic peripheral artery disease in a clinical practice population have a high risk of death and cardiovascular-related outcomes. Minimising risk is important in the ongoing management of these patients.

Keywords

Cardiovascular outcomes mortality observational study primary care database symptomatic peripheral artery disease

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References

Criqui

Aboyans

. Epidemiology of peripheral artery disease. Circ Res 2015; 116: 1509–1526.

Fowkes

Rudan

et al.

Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329–1340.

Tendera

Aboyans

Bartelink

et al.

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2851–2906.

Anderson

Halperin

Albert

et al.

Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: 1425–1443.

Norgren

Hiatt

Dormandy

et al.

Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45(Suppl S): S5–S67.

Rooke

Hirsch

Misra

et al.

2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58: 2020–2045.

Piepoli

Hoes

Agewall

et al.

2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23: NP1–NP96.

Alzamora

Fores

Pera

et al.

Ankle–brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort. BMC Cardiovasc Disord 2013; 13: 119–119.

Alberts

Bhatt

Mas

et al.

Three-year follow-up and event rates in the international REduction of Atherothrombosis for Continued Health Registry. Eur Heart J 2009; 30: 2318–2326.

10.

Grenon

Vittinghoff

Owens

et al.

Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: insights from the Heart and Soul Study. Vasc Med 2013; 18: 176–184.

11.

Bourke

Dattani

Robinson

. Feasibility study and methodology to create a quality-evaluated database of primary care data. Inform Prim Care 2004; 12: 171–177.

12.

Stuart-Buttle

Read

Sanderson

et al.

A language of health in action: Read Codes, classifications and groupings. Proc AMIA Annu Fall Symp 1996, pp. 75–79.

13.

In Practice Systems Ltd. Gemscript. www.inps.co.uk/ (accessed 28 September 2017).

14.

National Institute for Health and Care Excellence (NICE). Peripheral arterial disease: diagnosis and management (CG147). 2012. www.nice.org.uk/guidance/cg147/resources/peripheral-arterial-disease-diagnosis-and-management-35109575873989 (accessed 3 November 2016).

15.

Patel

Becker

Wojdyla

et al.

Cardiovascular events in acute coronary syndrome patients with peripheral arterial disease treated with ticagrelor compared with clopidogrel: data from the PLATO Trial. Eur J Prev Cardiol 2015; 22: 734–742.

16.

van Kruijsdijk

van der Graaf

Koffijberg

et al.

Cause-specific mortality and years of life lost in patients with different manifestations of vascular disease. Eur J Prev Cardiol 2016; 23: 160–169.

17.

Wallace

Salisbury

Guthrie

et al.

Managing patients with multimorbidity in primary care. BMJ 2015; 20: h176–h176.

18.

Grau

Baena-Diez

Felix-Redondo

et al.

Estimating the risk of peripheral artery disease using different population strategies. Prev Med 2013; 57: 328–333.

19.

Hennrikus

Joseph

Lando

et al.

Effectiveness of a smoking cessation program for peripheral artery disease patients: a randomized controlled trial. J Am Coll Cardiol 2010; 56: 2105–2112.

20.

Ramos

Garcia-Gil

Comas-Cufi

et al.

Statins for prevention of cardiovascular events in a low-risk population with low ankle brachial index. J Am Coll Cardiol 2016; 67: 630–640.

21.

Malyar

Furstenberg

Wellmann

et al.

Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. Eur Heart J 2013; 34: 2706–2714.

22.

Reinecke

Unrath

Freisinger

et al.

Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J 2015; 36: 932–938.

23.

Lewis

Schinnar

Bilker

et al.

Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf 2007; 16: 393–401.

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Cardiovascular outcomes for patients with symptomatic peripheral artery disease: A cohort study in The Health Improvement Network (THIN) in the UK

Abstract

Background

Methods

Results

Conclusion

Keywords

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References

Supplementary Material