Journal article
Long-Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long-Term Survival Study (PEARLS)
Journal of the American Heart Association, Vol.14(7), e038403
04/01/2025
DOI: 10.1161/JAHA.124.038403
PMCID: PMC12132885
PMID: 40118806
Abstract
Contemporary research in peripheral artery disease (PAD) remains limited due to lack of a national registry and low accuracy of diagnosis codes to identify patients with PAD.
Leveraging a novel natural language processing system that identifies PAD with high accuracy using ankle-brachial index and toe-brachial index values, we created a registry of 103 748 patients with new-onset PAD in the Veterans Health Administration. Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and non-Veterans Affairs encounters.
The mean age was 70.6 years; 97.3% were male, and 18.5% self-identified as Black. The mean ankle-brachial index value was 0.78 (SD: 0.26) and the mean toe-brachial index value was 0.51 (SD: 0.19). A majority of patients were current (27.1%) or former (30.0%) smokers. Prevalence of hypertension (86.6%), heart failure (22.7%), diabetes (54.8%), chronic kidney disease (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 7.0 per 100 patient-years.
We have successfully launched a registry of >100 000 patients with a new diagnosis of PAD in the Veterans Health Administration, the largest integrated health system in the United States. The incidence 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.
Details
- Title: Subtitle
- Long-Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long-Term Survival Study (PEARLS)
- Creators
- Saket Girotra - The University of Texas Southwestern Medical CenterQiang Li - The University of Texas Southwestern Medical CenterMary Vaughan-Sarrazin - University of IowaBrian C Lund - University of IowaMohammad Al-Garadi - Tennessee Valley Health System Veterans Affairs Medical Center Kansas City MOJoshua A Beckman - The University of Texas Southwestern Medical CenterRohit Nathani - The University of Texas Southwestern Medical CenterRichard M Hoffman - University of IowaPaul S Chan - University of Missouri–Kansas CitySubhash Banerjee - Baylor Scott & White HealthShirling Tsai - The University of Texas Southwestern Medical CenterDharam J Kumbhani - The University of Texas Southwestern Medical CenterNicole Minniefield-Young - The University of Texas Southwestern Medical CenterKim G Smolderen - Yale UniversityShipra Arya - Stanford MedicineCathy Nguyen - The University of Texas Southwestern Medical CenterMichael E Matheny - Vanderbilt University Medical CenterGlenn T Gobbel - VA Tennessee Valley Healthcare System
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.14(7), e038403
- DOI
- 10.1161/JAHA.124.038403
- PMID
- 40118806
- PMCID
- PMC12132885
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Publisher
- WILEY
- Grant note
- National Heart, Lung and Blood Institute (NHLBI): R01HL166305, R56HL158803 VA Office of Research and DevelopmentVA Office of Rural HealthNHLBI: R01HL160734 American Heart Association
This study is funded by the National Heart, Lung and Blood Institute (NHLBI, R01HL166305 and R56HL158803; PI: S. Girotra; Co-I: M. Vaughan-Sarrazin, B.C. Lund, M. Al-Garadi, J.A. Beckman, R.M. Hoffman, S. Tsai, K.G. Smolderen, S. Arya, M.E. Matheny, G.T. Gobbel). Dr Lund receives funding from the VA Office of Research and Development and the VA Office of Rural Health. Dr P.S. Chan and Dr Girotra also receive funding from the NHLBI (R01HL160734) and the American Heart Association. This material is the result of work supported with resources and the use of facilities at the Iowa City, Nashville, and North Texas Veterans Affairs. None of the funders had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
- Language
- English
- Electronic publication date
- 03/21/2025
- Date published
- 04/01/2025
- Academic Unit
- Health Management and Policy; Epidemiology; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984801618102771
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