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 Researchers looked at a decade of data on almost 21,000 veterans
hospitalized for "critical limb ischemia" - badly blocked arteries
that can lead to infections, gangrene and amputation. Left
untreated, the condition can quickly become fatal.
"These patients are at a serious threat of needing an amputation due
to the combination of poor circulation, impaired wound healing and
infection," senior study author Dr. Saket Girotra of the University
of Iowa and Iowa City VA Medical Center told Reuters Health by
email.
Between 2005 and 2014, the proportion of patients admitted to
Veterans Affairs (VA) healthcare facilities who underwent
revascularization procedures to unblock limb arteries climbed by
41%. Over the same period, amputations resulting from the condition
declined by 38% and fatalities decreased by 20%.
In 2005, almost one in five veterans had a major amputation within
90 days of being hospitalized for critical limb ischemia. By 2014,
only 13% of such patients got major amputations, the analysis found.
An uptick in the proportion of veterans prescribed statins to lower
their cholesterol, which can improve circulation, also may have
helped reduce the need for amputations, the study team notes in
Circulation: Cardiovascular Interventions.
Over the decade-long study, the proportion of patients prescribed
statins climbed from 47% to 61%.
Many patients were quite sick when they entered the hospital with
blocked leg arteries. Most had high blood pressure, two-thirds had
diabetes and more than one-quarter had kidney disease.
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The study looked at data for veterans treated at 115 VA hospitals
and found wide variation in the rates of revascularization and
amputation procedures, suggesting quality of care for this condition
may be uneven.
At hospitals that did the fewest procedures, only about 13% of
patients had revascularization, compared with 53% at hospitals that
did the most procedures.
One limitation of the study is that researchers used billing data,
which doesn't provide a complete medical picture for individual
patients or show all the factors that might have contributed to
treatment decisions and outcomes.
Even so, the results suggest the VA may be nimbler at treating
blocked leg arteries and getting better results than are typically
seen in other hospitals and health systems, said Dr. Philip Goodney,
of the Geisel School of Medicine at Dartmouth in Lebanon, New
Hampshire.
"This study shows that veterans treated for severe leg blockages
have a lower chance of dying, and a much lower chance of losing
their leg, than they did a decade ago," Goodney, who wasn't involved
in the study, said by email. "Given the multidisciplinary nature of
treatments provided in the VA, this suggests that even difficult
healthcare challenges can be improved with team-based approaches."
SOURCE: https://bit.ly/2SVsXid Circulation: Cardiovascular
Interventions, online February 13, 2020.
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