Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management.
OBJECTIVE
The purpose of this study was to determine whether a strategy of aggressive cardiovascular risk management reduced the mortality associated with diabetic foot ulceration.


METHODS
After an initial audit of outcomes demonstrating a high mortality rate in 404 diabetic foot ulcer patients with the first ulceration developing between 1995 and 1999, a new aggressive cardiovascular risk policy was introduced as standard practice at the Diabetic Foot Clinic, Royal Infirmary of Edinburgh, in 2001. In the first 3 years of this policy, 251 patients were screened and identified. The audit cycle was then closed by reauditing the 5-year mortality for this second group of foot ulcer patients in 2008.


RESULTS
Overall 5-year mortality was reduced from 48.0% in cohort 1 to 26.8% in cohort 2 (P < 0.001). Improvement in survival was seen for both neuroischemic patients (5-year mortality of 58% reduced to 36%; relative reduction 38%) and neuropathic patients (36% reduction to 19%; relative reduction 47%) (both P < 0.001). Patients were more likely to die if they were older at the time of ulceration or had type 2 diabetes, renal impairment, or preexisting cardiovascular disease or were already taking aspirin. Prior statin use, current smoker or ex-smoker status, blood pressure, A1C, and total cholesterol were not significantly different between survivors and those who died in the follow-up periods.


CONCLUSIONS
Diabetic foot ulcer patients have a high risk of death. Survival has improved over the past 13 years. The adoption of an aggressive cardiovascular risk management policy in diabetic foot ulcer clinics is recommended for these patients.
Young
Matthew J
MJ
Diabetic Foot Clinic, The Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK. matthew.young@luht.scot.nhs.uk
McCardle
Joanne E
JE
Randall
Luann E
LE
Barclay
Janet I
JI
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D017719:Diabetic Foot / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology