Vascular hospitalization rates and costs in patients with peripheral artery disease in the United States.

Abstract

BACKGROUND:

Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events. The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international prospective registry of patients at risk of atherothrombosis caused by established arterial disease or the presence of ≥3 atherothrombotic risk factors.

METHODS AND RESULTS:

We compared the 2-year rates of vascular-related hospitalizations and associated costs in US patients with established PAD across patient subgroups. Symptomatic PAD at enrollment was identified on the basis of current intermittent claudication with an ankle-brachial index (ABI) <0.90 or a history of lower-limb revascularization or amputation. Asymptomatic PAD was diagnosed on the basis of an enrollment ABI <0.90 in the absence of symptoms. Overall, 25 763 of the total 68 236-patient REACH cohort were enrolled from US sites; 2396 (9.3%) had symptomatic and 213 (0.8%) had asymptomatic PAD at baseline. One- and cumulative 2-year follow-up data were available for 2137 (82%) and 1677 (64%) of US REACH patients with either symptomatic or asymptomatic PAD, respectively. At 2 years, mean cumulative hospitalization costs, per patient, were $7445, $7000, $10 430, and $11 693 for patients with asymptomatic PAD, a history of claudication, lower-limb amputation, and revascularization, respectively (P=0.007). A history of peripheral intervention (lower-limb revascularization or amputation) was associated with higher rates of subsequent procedures at both 1 and 2 years.

CONCLUSIONS:

The economic burden of PAD is high. Recurring hospitalizations and repeat revascularization procedures suggest that neither patients, physicians, nor healthcare systems should assume that a first admission for a lower-extremity PAD procedure serves as a permanent resolution of this costly and debilitating condition.

• Authors: Elizabeth M Mahoney, Kaijun Wang, Hong H Keo, Sue Duval, Kim G Smolderen, David J Cohen, Gabriel Steg, Deepak L Bhatt, Alan T Hirsch, Reduction of Atherothrombosis for Continued Health (REACH) Registry Investigators
• Journal: Circulation. Cardiovascular quality and outcomes (Circ Cardiovasc Qual Outcomes) Vol. 3 Issue 6 Pg. 642-51 (Nov 2010) ISSN: 1941-7705 [Electronic] United States
• PMID: 20940249 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Amputation, Surgical (economics)
• Cost of Illness
• Female
• Follow-Up Studies
• Hospitalization (statistics & numerical data, trends)
• Humans
• Male
• Middle Aged
• Peripheral Arterial Disease (economics, epidemiology, physiopathology, therapy)
• Registries
• Reperfusion (economics)
• Risk Factors
• United States