BACKGROUND PAD increases the risk of cardiovascular mortality and limb loss, and disparities in treatment and outcomes have been described. However, the association of patient-specific characteristics with variation in outcomes is less well known. METHODS Patients with PAD from Duke University Health System (DUHS) between January 1, 2015 and March 31, 2016 were identified. PAD status was confirmed through ground truth adjudication and predictive modeling using diagnosis codes, procedure codes, and other administrative data. Symptom severity, lower extremity imaging, and ankle-brachial index (ABI) were manually abstracted from the electronic health record (EHR). Data was linked to Centers for Medicare and Medicaid Services data to provide longitudinal follow up. Primary outcome was major adverse vascular events (MAVE), a composite of all-cause mortality, myocardial infarction (MI), stroke, lower extremity revascularization and amputation. RESULTS Of 1,768 patients with PAD, 31.6% were asymptomatic, 41.2% had intermittent claudication (IC), and 27.3% had chronic limb-threatening ischemia (CLTI). At 1 year, patients with CLTI had higher rates of MAVE compared with asymptomatic or IC patients. CLTI and Medicaid dual eligibility were independent predictors of mortality. CLTI and Black race were associated with amputation. CONCLUSIONS Rates of MAVE were highest in patients with CLTI, but patients with IC or asymptomatic disease also had high rates of adverse events. Black and Medicaid dual-eligible patients were disproportionately present in the CLTI subgroup and were at higher risk of amputation and mortality, respectively. Future studies must focus on early identification of high-risk patient groups to improve outcomes in patients with PAD.

中文翻译：

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医疗保健差异和患者特定因素与外周动脉疾病临床结果的关联。


背景 PAD 会增加心血管死亡和肢体丧失的风险，并且已经描述了治疗和结果的差异。然而，患者特定特征与结果变化之间的关联却鲜为人知。方法 确定杜克大学医疗系统 (DUHS) 2015 年 1 月 1 日至 2016 年 3 月 31 日期间患有 PAD 的患者。 PAD 状态是通过使用诊断代码、程序代码和其他管理数据进行地面实况裁决和预测模型来确认的。症状严重程度、下肢影像学和踝臂指数 (ABI) 是从电子健康记录 (EHR) 中手动提取的。数据与医疗保险和医疗补助服务中心的数据相关联，以提供纵向随访。主要结局是主要不良血管事件（MAVE），包括全因死亡率、心肌梗死（MI）、中风、下肢血运重建和截肢。结果 1,768 名 PAD 患者中，31.6% 无症状，41.2% 有间歇性跛行 (IC)，27.3% 有慢性肢体威胁性缺血 (CLTI)。 1 年时，与无症状或 IC 患者相比，CLTI 患者的 MAVE 发生率更高。 CLTI 和医疗补助双重资格是死亡率的独立预测因素。 CLTI 和黑人种族与截肢有关。结论 CLTI 患者的 MAVE 发生率最高，但 IC 或无症状疾病患者的不良事件发生率也很高。黑人和具有医疗补助双重资格的患者在 CLTI 亚组中所占比例过高，并且分别面临较高的截肢和死亡风险。未来的研究必须侧重于早期识别高危患者群体，以改善 PAD 患者的预后。