jueves, 6 de diciembre de 2012

Temporal trends and geographic variation o... [J Am Coll Cardiol. 2012] - PubMed - NCBI

Temporal trends and geographic variation o... [J Am Coll Cardiol. 2012] - PubMed - NCBI


Leg Amputations for Peripheral Artery Disease Declining for SeniorsAmputations decreased significantly among patients 65 and older with lower-extremity peripheral artery disease from 2000 to 2008, a new AHRQ-funded study shows.  The incidence rate declined from 7,258 per 100,000 patients in 2000 to 5,790 per 100,000 patients in 2008.  The authors suggest that better detection practices for vascular disease and improved revascularization treatment may account for the significant decline.  The analysis, based on CMS fee-for-service Medicare data, also showed significant patient and geographic variation in amputation rates across the United States.  The study, “Temporal Trends and Geographic Variation of Lower-Extremity Amputation in Patients With Peripheral Artery Disease: Results from US. Medicare 2000-2008,” was published online October 24 in the Journal of the American College of Cardiology.  Select to access the abstract on PubMed.®

2012 Nov 20;60(21):2230-6. doi: 10.1016/j.jacc.2012.08.983. Epub 2012 Oct 24.

Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease: results from u.s. Medicare 2000-2008.

Source

Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina. Electronic address: schuyler.jones@dm.duke.edu .

Abstract

OBJECTIVES:

This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period.

BACKGROUND:

Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation.

METHODS:

By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors.

RESULTS:

Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001).

CONCLUSIONS:

From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States.
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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