Categorization of patients with peripheral artery disease by charlson comorbidity index

Background Multidisciplinary vascular medicine teams have emerged as the standard of care for patients suffering from peripheral arterial disease (PAD). As medical treatments improved, long term prognosis increased, and it appears reasonable that also PAD patients are more likely to suffer from comorbidities. However, data analyzing to verify this assumption is rare. Little is known on the impact of the comorbidities on the PAD treatment and survival. Still, full consideration of morbidity burden might be even more important in the context of the growing need to perform interventional procedures as outpatient care. The Charlson Comorbidity Index (CCI) is the most extensively studied tool for detecting comorbidity burden, but data on the subgroup of PAD patients are limited. This study aimed to assess the prevalence and temporal trends of comorbidity burden in PAD patients, and its influence on the treatment and complications. Methods The Research Data Center of the Federal Bureau of Statistics analysed the German nationwide inpatient statistics data on our behalf. All patients admitted due to PAD in Germany 2005-2022 were included. For each, the CCI was calculated, compared the CCI classes (very-low: CCI=0 points, mild: CCI=1-2 points, moderate: CCI=3-4, high severity: CCI>4 points) and the impact of CCI class on outcomes was assessed (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005-2022, own calculations). Results The analysis identified 3,167,987 hospitalizations. Of these, 327,595 patients (10.3%) had a mild, 1,086,587 (34.3%) had a moderate, and 1,753,805 (55.4%) had a high severity CCI score. The annual number of hospitalizations increased with a peak in 2016/2017, decreased in the year 2020, and has not yet reached its pre-pandemic level. The proportion of patients with a high severity CCI score increased from 51.2 % in 2006 to 58.5% in 2022. Over the same period, the proportion of mild CCI scores decreased from 11.7% to 7.2%. An increase in the CCI class was associated with an increased likelihood of being treated endovascularly (OR 1.48, 95% CI 1.48-1.49 p<0.001) rather than surgically (OR 0.87, 95% CI 0.87 - 0.88, p<0.001). An increase in the CCI class was associated with an elevated risk for major adverse cerebro- and cardiovascular events (MACCE) (OR 1.61, 95% CI 1.61-1.61, p<0.001), as well as amputation (OR 1.33, 95% CI 1.33-1.33, p<0.001)and in-hospital mortality (OR 1.58, 95% CI 1.58-1.59, p<0.001). Conclusion The comorbidity burden of patients hospitalized for PAD in Germany increased during the observational period. A higher comorbidity burden mirrored by a higher CCI class was associated with an increased risk for MACCE and even in-hospital mortality in the short term. In this context, physicians had to be aware of the impact of the comorbidity burden in this crucial patient group.