By Lisa Rapaport
(Reuters Health) – A growing number of older U.S. military veterans with blocked leg arteries are getting procedures to restore blood flow, and a new study suggests deaths and amputations are declining as a result.
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.
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.