6/12/2014. Peripheral Arterial Disease US Population. Defining CLI and the Scope of the Problem. Defining CLI and the Scope of the Problem

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1 6/12/2014 Defining CLI and the Scope of the Problem Defining CLI and the Scope of the Problem Barry T. Katzen, MD Founder and Executive Medical Director Clinical Professor of Radiology and Surgery FIU Herbert Wertheim College of Medicine Barry T. Katzen, MD Founder and Executive Medical Director Clinical Professor of Radiology and Surgery FIU Herbert Wertheim College of Medicine Peripheral Arterial Disease Reasons for increased prevalence of PAD and CLI Aging - 80% US Population CLI in patients > 65 years Epidemic of diabetes - 31% prevalence of diabetes in >65 year old population - 60% of CLI patients = diabetics - 40% prevalence of PAD in Diabetics Estimated annual economic cost (2004) of PAD: $102 Billion Clinically at MCVI we are seeing increasing numbers of Patients with CLI, decreasing numbers with claudication What role does the healthcare system play in shift of severity of disease? 3 / U.S. Census Bureau / National Health and Nutrition Examination Survey 1

2 Prevalence of Peripheral Artery Disease (PAD) and Critical Limb Ischemia (CLI) in the US Million US citizen PAD 2010 PAD 2020 CLI 2010 CLI 2020 THE SAGE GROUP, Atlanta, Medicare data Jan 2007-Dec 2008 Potential risk factors taken in to account Prevalence: 0.23% Incidence: 0.20% Diabetes: 7.6x increased risk Black patients: lower revascularization probability and higher amputation probability than white patients 6 Incidence and Prevalence Issues Estimated: 1% of Americans over the age of 50, may ultimately acquire CLI Sage Group: est. 2 million increasing to 2.8 million by 2020 Prompt appropriate care is the key to favorable and beneficial outcomes Variability in Care: In some regions 80% received revasc procedure within 12 months of amputation, and others 12% 7 8 2

3 Time to Death: Patients with Amp. After CLI CLI: 68,074 Death: 8, Time to Death for CLI Patients Time to First,, Second, and Third Notntraumatic amputation events for CLI Patients CLI: 68,074 Death: 20,

4 Background and Objectives CLI: the most severe manifestation of peripheral arterial disease High rates of stroke, MI, and amputation High cost to the healthcare system both acutely leading up to amputation and in the rehab and recovery time periods Objective: identify incidence and develop methodology for surveillance, evaluate healthcare costs Results 4302 hospitalizations for LLA ( ) Major 1831(43%) Minor 2470 ( 57%) Diabetes (72%) Age adjusted amputation rate:20/100,000, stroke rate 38/100k, mortality for diabetes, stroke 20-21/100k Population Characteristics

5 Comparative Frequencies Inpatient Costs Summary CLI is a significant public health problem that is growing Significant costs related to amputation, independent from rehab and return to normal life Amputation rates are similar to diabetic related mortality, and stroke mortality Patients with CLI have associated significant mortality rates over time

6 Critical Limb Ischemia Variabilities and data collection and reporting Relatively poorly studied compared to STEMI, STROKE Lack of uniform definitions for reporting standards Academic Research Consortium: efforts in STEMI, Bleeding, device trial conformability 21 6

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8 CLI Miami Increase awareness Earlier diagnosis and treatment planning Development of integrated team approach: prevention, medical management, wound care, revascularization Create an imperative to improve mortality in patients with CLI 30 CLI Miami Multidisciplinary Faculty Broad Scope Fundamentals (including live video vascular examination) Understand Treatment strategies, including the basics of wound care today, future directions and surgical and endovascular revascularization CLI Miami Multidisciplinary Faculty Broad Scope Fundamentals (including live video vascular examination) Understand Treatment strategies, including the basics of wound care today, future directions and surgical and endovascular revascularization