According to an observational study published November 2012 in the Journal of the American College of Cardiology, from 2000 to 2008, the rate of peripheral artery disease (PAD)-related lower-limb amputations decreased, yet “significant” patient and geographic variations in amputation rates across the United States remains.
A team of researchers from Duke University, Durham, North Carolina, examined Centers for Medicare & Medicaid Services (CMS) data from January 1, 2000, to December 31, 2008, to determine national patterns of lower-limb amputations among patients 65 years and older who had PAD. The objective of the study was to identify trends relating to time, patient-specific factors, and geographic variations associated with the amputations.
Their study showed that among 2,730,742 older patients with identified PAD, the overall rate of lower-limb amputation decreased about 20 percent, from 7,258 to 5,790 per 100,000. Overall, 6.8 percent, or 186,338, patients who were hospitalized with PAD underwent lower-limb amputation during the study period. Male gender, African American race, diabetes mellitus, and renal disease were all independent predictors of lower-limb amputation, they said.
As reported in Cardiovascular Business, 65 percent of the patients who underwent lower-limb amputation were 75 years old or older, about 50 percent were men, and 25 percent were African American. Patients with PAD who underwent amputation were more likely to be black (28.1 versus 9.5 percent), to have diabetes mellitus (60.3 versus 35.7 percent), and to have renal disease (29.5 versus 15.5 percent) when compared with patients with PAD who did not undergo an amputation. Further, geographic data for lower-limb amputations varied from 8,400 amputations per 100,000 patients with PAD in the East South Central region to 5,500 amputations per 100,000 patients with PAD in the Mountain region.
Based on their findings, the study authors suggested that future research should try to determine the causes that resulted in the observed reduction in amputations and geographic variation. They also said the study indicates the need for education programs for clinicians and patients that will focus on best practices for the prevention and treatment of PAD in patients at risk for [lower-limb] amputation nationwide.
Editor’s note: This story was adapted from materials provided by the Journal of the American College of Cardiology.