PAD: Trends in Hospital Outcomes and Morbidity Interview with:
Nasser Malyar, MD

Division of Vascular Medicine
Department of Cardiovascular Medicine
University Hospital Muenster
Albert-Schweitzer-Campus 1, A1
48149 Muenster, Germany What are the main findings of the study?

Dr. Malyar: The main findings of the study were that

1) PAD as a main or co-diagnosis is common among in-hospital treated patients

2) The prevalence of PAD among hospitalized patients is disproportionately increasing, particularly in the subset with critical limb ischemia

3) Despite all efforts and increasingly use of endovascular and surgical revascularization procedures PAD patients still have a poor in-hospital outcome in terms of limb amputation and in-hospital mortality

4) Last but not least the reimbursement costs for in-hospital treatment of patients with PAD are markedly increasing. Were any of the findings unexpected?

Dr. Malyar: Previous population-based estimations predicted an increase of PAD due to ageing of population and increase of atherosclerotic risk factors in general and especially of those having critical limb ischemia. However, the magnitude of the increase we found was unexpectedly high. It was also striking that the rate of limb amputation and mortality among PAD patients during the index hospitalization remains alarmingly high with only a slight trend towards decreasing rate in both outcome measures. What should clinicians and patients take away from your report?

Dr. Malyar: The data presented should help to increase the awareness for PAD in general, and the prognostic implication of this disease among patients, physicians and all other health care providers. Early recognition and application of adequate therapeutic measures might not only impact the direct limb related functional status and quality of life but also the general prognosis of these underdiagnosed and undertreated patients. What recommendations do you have for future research as a result of this study?

Dr. Malyar: From other reports and the current guidelines there is a clear recommendation for diagnostic angiography and revascularization in all patients wit critical limb ischemia. Nevertheless, although this was not in the focus of our study, the rates of angiography and revascularization were surprisingly low in this contemporary cross-sectional analysis. Thus, these data demonstrate the need for a more focused and dedicated clinical research and cooperation of diverse disciplines involved in the medical management of vascular patients to develop strategies for reducing the still high number of limb amputations and the excessive high mortality rates among PAD patients.


Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis Eur Heart J first published

Nasser Malyar, Torsten Fürstenberg, Jürgen Wellmann, Matthias Meyborg, Florian Lüders, Katrin Gebauer, Holger Bunzemeier, Norbert Roeder, and Holger Reinecke
online July 17, 2013 doi:10.1093/eurheartj/eht288


Last Updated on September 13, 2013 by Marie Benz MD FAAD