Worse Outcomes Seen With Loss to Follow-Up at 1 Year After Lower Extremity Interventions

 

June 28, 2019—In Vascular Medicine, Grace J. Wang, MD, et al published a study showing that loss to follow-up (LTF) at 1 year after lower extremity peripheral vascular intervention (PVI) is associated with worse survival. The investigators sought to identify differences in lower extremity PVI patients with and without LTF and determine if LTF impacted survival.

As summarized in Vascular Medicine, the analysis was composed of patients (N = 39,342) in the PVI registry of the Vascular Quality Initiative. They used t-test and chi-squared analysis to compare those with and without LTF. Multivariable logistic regression was used to identify factors associated with LTF, and Cox regression analysis was applied to compare survival among those with and without LTF.

The investigators reported that the overall 1-year follow-up rate was 91.6%. LTF patients were more often men, Hispanic, and of black race and had a higher rate of diabetes, coronary artery disease, congestive heart failure, and dialysis. LTF patients had a higher prevalence of critical limb ischemia, underwent popliteal or distal intervention, and were intervened upon urgently. There was also a higher rate of postoperative complications and a lower rate of technical success for LTF patients.

After controlling for center effects, the investigators found the following:

  • Independent variables associated with LTF included male sex, age, diabetes, dialysis dependence, American Society of Anesthesiologists class ≥ 3, and complications requiring admission.
  • Factors that were protective against LTF included preoperative aspirin, home preadmission living status, previous carotid intervention, and discharge aspirin.
  • Adjusted survival analysis showed decreased survival in LTF, with those returning face-to-face surviving longer than those with phone follow-up.

Efforts should be focused on understanding these differences to improve follow-up rates and help improve overall survival, concluded the investigators in Vascular Medicine.

 

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