
==== Front
medRxiv
MEDRXIV
medRxiv
Cold Spring Harbor Laboratory

10.1101/2024.08.20.24312328
preprint
1
Article
Long-term Outcomes of Peripheral Artery Disease In Veterans: Analysis of the PEripheral ARtery Disease Long-term Survival Study (PEARLS)
Girotra Saket http://orcid.org/0000-0002-4784-4513

Li Qiang
Vaughan-Sarrazin Mary http://orcid.org/0000-0001-8717-1061

Lund Brian C. http://orcid.org/0000-0001-5191-728X

Al-Garadi Mohammad
Beckman Joshua A. http://orcid.org/0000-0001-8332-8439

Nathani Rohit
Hoffman Richard M.
Chan Paul S. http://orcid.org/0000-0002-5185-3367

Banerjee Subhash
Tsai Shirling
Kumbhani Dharam J. http://orcid.org/0000-0003-4321-4538

Minniefield-Young Nicole
Smolderen Kim G. http://orcid.org/0000-0001-6104-6254

Arya Shipra http://orcid.org/0000-0002-0404-9325

Nguyen Cathy
Matheny Michael E. http://orcid.org/0000-0003-3217-4147

Gobbel Glenn T.
21 8 2024
2024.08.20.24312328https://creativecommons.org/licenses/by-nc/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
http://medrxiv.org/lookup/doi/10.1101/2024.08.20.24312328
nihpp-2024.08.20.24312328.pdf
Abstract

Background

Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify PAD patients in electronic health records.

Methods & Results

Leveraging a novel natural language processing (NLP) system that identifies PAD with high accuracy using ankle brachial index (ABI) and toe-brachial index (TBI) values, we created a registry of 103,748 patients with new onset PAD patients in the Veterans Health Administration (VHA). Study endpoints include mortality, cardiovascular (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using VA and non-VA encounters. The mean age was 70.6 years; 97.3% were males, and 18.5% self-identified as Black race. The mean ABI value was 0.78 (SD: 0.26) and the mean TBI value was 0.51 (SD: 0.19). Nearly one-third (32.4%) patients were currently smoking and 35.4% formerly smoked. Prevalence of hypertension (86.6%), heart failure (22.7%), diabetes (54.8%), renal failure (23.6%), and chronic obstructive pulmonary disease (35.4%) was high. At 1-year, 9.4% of patients had died. The 1-year incidence of cardiovascular events was 5.6 per 100 patient-years and limb events was 4.5 per 100 patient-years.

Conclusions

We have successfully launched a registry of >100,000 patients with a new diagnosis of PAD in the VHA, the largest integrated health system in the U.S. The ncidence of death and clinical events in our cohort is high. Ongoing studies will yield important insights regarding improving care and outcomes in this high-risk group.
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