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OBJECTIVE: Lower extremity peripheral arterial disease (PAD) is a severe condition that increases the risk of major adverse cardiovascular events, major adverse limb events, and all cause mortality. This study aimed to investigate the mortality risk among females and males hospitalised for the first time with lower extremity PAD. METHODS: Three cohorts of patients who were admitted for the first time with lower extremity PAD in 2007 - 2010, 2011 - 2014, and 2015 - 2018 were constructed. For the 2007 - 2010 and 2011 - 2014 cohorts, the 28 day, one year, and five year mortality rates were calculated, assessing survival time from date of hospital admission until date of death, end of study period, or censoring. For the 2015 - 2018 cohort, only 28 day and one year mortality were investigated due to lack of follow up data. Mortality rates of these cohorts were compared with the general population using standardised mortality rates (SMRs), and the risk of death between sexes was evaluated using Cox proportional hazards models. Cox models were adjusted for age, cardiovascular disease, and diabetes mellitus to account for potential confounding factors. RESULTS: In total, 7 950, 9 670, and 13 522 patients were included in the 2007 - 2010, 2011 - 2014, and 2015 - 2018 cohorts, respectively. Over 60% of individuals in each cohort were males. Mortality rates at 28 day and one year remained stable across all cohorts, while the five year mortality rate increased for both males and females in the 2011 - 2014 cohort. The SMRs both of females and males with PAD were significantly higher than in the general population. Multivariable regression analyses found no significant differences in mortality risk between sexes at 28 day and one year. However, the five year mortality risk was lower in females, with a hazard ratio of 0.89 (95% confidence interval [CI] 0.83 - 0.97) in the 2007 - 2010 cohort and 0.88 (95% CI 0.82 - 0.94) in the 2011 - 2014 cohort. CONCLUSION: The five year mortality risk has increased, and females face a lower mortality risk than males. Lower extremity PAD still carries unfavourable long term consequences compared with the general population.
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OBJECTIVE: Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I - III or Rutherford category 0 - 4. DATA SOURCES: PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD. REVIEW METHODS: Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated. RESULTS: Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of mortality in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias. CONCLUSION: This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient population, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I - III or Rutherford category 0 - 4.
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OBJECTIVE: To evaluate the differences in symptoms between men and women that present with lower limb peripheral artery disease (PAD). DATA SOURCES: Systematic review and meta-analysis using PubMed, EMBASE, and the Cochrane Library. REVIEW METHODS: A systematic search of the literature to identify studies that examined PAD and its symptoms using PubMed, EMBASE, and the Cochrane Library, which were screened in duplicate by two reviewers. Information on study design, source of data, population characteristics, and outcomes of interest was extracted and used the Newcastle-Ottawa Scale and Cochrane risk of bias tool. Quality of evidence was rated using the GRADE methodology. Estimates of relative effects were pooled to generate pooled odds ratios (OR) and their 95% confidence interval (CI) using a random effects model. RESULTS: Thirteen cross sectional studies, six cohorts, one case control, and one randomised clinical trial, reporting on 1 929 966 patients with confirmed PAD (established by clinical history, clinical examination, and/or ankle brachial index, or further tests) were included. Women presented less often with intermittent claudication than men (25.9% vs. 30.2%) OR 0.78 (95% CI 0.72 - 0.84, very low quality of evidence), while rest pain and atypical leg symptoms were more prevalent in women (12.8% vs. 9.2%) OR 1.40 (95% CI 1.22 - 1.60, very low quality of evidence) and (22.8% vs. 19.8%) OR 1.18 (95% CI 0.96 - 1.45, very low quality of evidence), respectively. CONCLUSION: Women with PAD more often present with rest pain, while their prevalence of intermittent claudication is lower. They also tend to present more often with atypical leg symptoms. This study underlines that PAD symptom presentation differs between the sexes. Therefore, clinicians and researchers should not consider men and women as a single population and report their data separately.