The Impact of Outpatient Pathways and Pre-Admission Diagnosis on Short Term Mortality and Amputation Risk after Revascularisation in Women and Men With Peripheral Arterial Disease, and Analysis of Health Insurance Claims Data.

Abstract

Patients with lower extremity peripheral arterial disease (PAD) often present with advanced disease at their first hospital admission. This study explored previous outpatient care pathways, particularly whether a pre-admission PAD diagnosis was present, and their role for outcomes of invasive revascularisation considering sex specific differences. Patients with an index admission for symptomatic PAD between 01 January 2015 and 31 December 2018 were identified from nationwide longitudinally linked health insurance claims data provided by BARMER, the second largest insurance provider in Germany. Information on outpatient and inpatient diagnoses, procedures, medical specialist contacts, and filled prescriptions were assessed up to ten years before index hospitalisation. Using both Cox proportional hazard and logistic regression models, associations between these variables and the three month all cause mortality and in hospital amputation rates were examined. A total of 34 918 patients (46.9% women) were included. Women (vs. men) were older, more often suffered from ischaemic rest pain, and less often received lipid lowering drugs and antiplatelets when being admitted to a hospital for first invasive revascularisation. In adjusted analyses, a pre-admission PAD diagnosis before the index hospitalisation was associated with 20% (women) to 29% (men) lower hazards for all cause three month death, and 24% (women) to 28% (men) lower odds for any amputation during the index hospitalisation. A pre-admission PAD diagnosis was associated with a greater number of doctor consultations (e.g., cardiology) and higher prescription rates for lipid lowering drugs and antiplatelets before admission. The current study emphasised an association between pre-admission PAD diagnosis and short term outcomes of index revascularisation, emphasising the need for further studies on the benefit of risk based screening and timely diagnostic workup of affected people.