A Population-Based Study of Incidence, Risk Factors, Outcome and Prognosis of Ischaemic Peripheral Arterial Events: Implications for Prevention
Background—There are few published data on the incidence and long-term outcomes of critical limb ischemia (CLI), acute limb ischemia (ALI), or acute visceral ischemia (AVI) with which to inform health service planning, monitor prevention and enable risk prediction.
Methods and Results—In a prospective population-based study (Oxfordshire, UK, 2002-2012), we determined incidence and outcome of all acute peripheral arterial events in a population of 92,728. Risk factors were assessed by comparison with the underlying population. 510 acute events occurred in 386 patients requiring 803 interventions. 221(59.3%) patients were aged ≥75yrs and 98(26.3%) ≥85 years. 230(62.3%) patients were independent prior to event, but 270(73.4%) were dead or dependent at 6 month follow-up and 328(88.9%) at 5 years. 30-day survival was lowest for AVI (28.2%) compared to ALI (75.3%) and CLI (92.6%) (p<0.001). Risk factors (all p<0.001) were hypertension (age-sex-adjusted RR 2.75,1.95-3.90), smoking (2.14,1.37-3.34), and diabetes (3.01, 1.69-5.35; particularly for CLI (5.96,3.15-11.26). 288(77.2%) patients had known prior cardiovascular disease and 361(96.8%) had vascular risk factors, but only 203(54.4%) were on an antiplatelet and only 166(44.5%) on a statin. Although 260(69.7%) patients were taking antihypertensives, 42.9% of all BPs recorded during the 5-years prior-to-event were >140/90. Of 88(23.6%) patients with incident cardio-embolic events, 62 had known AF (diagnosed prior-to-event), of whom only 14.5% were anticoagulated despite 82.3% having CHA2DS2VASC scores ≥2 without contraindications.
Conclusions—The clinical burden of peripheral arterial events is substantial. Although the vast majority of patients have known vascular disease in other territories and multiple treatable risk factors, premorbid control is poor.
- Received March 13, 2015.
- Revision received August 14, 2015.
- Accepted August 24, 2015.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial License (http://creative commons.org/licenses/by-nc/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited and is not used for commercial purposes.