title: Evaluation of the consequences associated with diffuse vascular disease history in patients diagnosed with peripheral arterial disease: estimates from Saskatchewan health data.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is caused by narrowing of the arteries in the lower extremities. Limited data exist concerning the impact of diffuse vascular disease (DVD) on prognosis and costs. Thus, the objective of this study is to estimate the impact of DVD on morbidity, mortality and costs.
  
  
  METHODS
  PAD was identified between 1985 and 1995 and classified by extent of DVD at diagnosis: none (PAD only, reference group), prior myocardial infarction (MI), prior stroke, prior MI and stroke (MI + stroke), prior transient ischemic attack (TIA). Deaths and hospitalizations were identified through December 2000. Hospitalization costs were estimated from the Ontario Case Cost Project, reported in 2002 $CAD. Proportional hazards analyses measured the impact of vascular involvement on mortality while controlling for risk factors (e.g., age, cardiovascular history).
  
  
  RESULTS
  Overall, 16,439 patients with PAD were included; 14.8% had a prior MI, 10.2% a prior stroke, 2.6% prior MI + stroke, 6.4% prior TIA, two-thirds had PAD only. Median survival was shorter for patients with prior MI (9.3 yrs), TIA (6.3), stroke (4.7), and MI+stroke (4.1) versus the reference group (9.9, p < 0.05, all comparisons). Analyses revealed that the death risk was 60% higher in patients with prior stroke and 84% higher for MI + stroke. Atherothrombotic and bleeding event-related costs were $712, $337, $268, and $170 higher per patient/year of follow-up in patients with a history of MI+stroke, MI, stroke, and TIA, respectively.
  
  
  CONCLUSIONS
  Patients diagnosed with PAD with DVD have higher risk of poor outcomes and increased costs.
authors.affiliation: United BioSource Corporation, Lexington, MA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Migliaccio-Walle
authors.forename: Michael
authors.initials: M
authors.lastname: Stokes
authors.forename: Irina
authors.initials: I
authors.lastname: Proskorovsky
authors.forename: Dan
authors.initials: D
authors.lastname: Popovici-Toma
authors.forename: Wissam
authors.initials: W
authors.lastname: El-Hadi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012306:Risk; D012525:Saskatchewan; D020521:Stroke / Q000453:epidemiology*; D016896:Treatment Outcome
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