Abstract 3701: High All-Cause Mortality in Patients with Peripheral Arterial Disease in Primary Care: Five-Year Results of the getabi Study
Peripheral arterial disease (PAD) is widely accepted as an indicator for generalized atherosclerosis. We aimed to quantify the excess mortality risk borne by symptomatic and asymptomatic PAD patients compared to those without PAD in a sample of elderly patients. The German Epidemiological Trial on Ankle Brachial Index (getABI) is a large-scale prospective observational epidemiological 5-year study in 6,880 unselected patients ≥65 years in 344 representative offices. The prevalence and incidence of PAD (defined as ABI < 0.9) was determined with standardized Doppler sonography. Death of any cause and severe vascular events were reported by GPs and verified by hospital data (on-site monitored study). To determine relative risk elevations between patients with and without PAD, hazard rate ratios (HRR) were calculated using a multivariate Cox regression model adjusted for age, gender, body mass index and known coronary artery disease (CAD) risk factors. The prevalence of PAD in the cohort was 18.0% at baseline. At 5 years, the survival status of 6701 (97.4%) patients is known. Among these, all-cause mortality was 24.1% in patients with symptomatic PAD, 19.2% in patients with asymptomatic PAD (low ABI), and 9.5% in patients without PAD (symptomatic versus asymptomatic PAD: adjusted HRR 1.1 [95% confidence interval: 0.9 –1.4], asymptomatic PAD versus no PAD: HRR 1.6 [1.3–2.0 ]). Low ABI categories were assciated with higher rates of death. For example, in patients with an ABI <0.5, all-cause mortality at 5 years was 31.4%, while in patients with an ABI >= 1.1 it was 8.6%. After multivariate statistical adjustment for known cardiovascular risk factors, presence of PAD was a strong predictor for mortality at 5 years (HRR 1.4 [1.3–1.5], p<.001). PAD patients carry a substantially increased risk for all-cause mortality. While symptomatic PAD patients had a numerically higher risk than asymptomatic PAD patients, the difference was not significant after adjustment for other risk factors. Our data strongly support the rationale to screen primary care patients for PAD by determination of the ABI. This might ensure timely and comprehensive treatment of their modifiable atherosclerotic risk factors, and support patient compliance to the efforts in vascular prevention.