Study Compares Long-Term Outcomes and Costs of CLI Treatment

August 15, 2018—The American Heart Association (AHA) announced the publication of a study on the determinants of the long‐term outcomes and costs in the management of critical limb ischemia (CLI) online by Jihad Mustapha, MD, et al in Journal of the American Heart Association. The AHA reported that the study found that revascularization of the lower limbs of patients with CLI may be cheaper and associated with longer survival than amputation.

In the study, the investigators examined Medicare records of 72,199 patients diagnosed with primary CLI from 2010 to 2015. Medicare is the primary payer for approximately 75% of CLI-related hospitalizations and therefore represents the cross-section of CLI-related outcomes nationwide.

According to the AHA, it is estimated that 29% of patients diagnosed with CLI either will die or have an amputation performed within the first year, and many will undergo several revascularization procedures during the median 3.5-year survival period of the study.

Over the 4 years of the study, the investigators found that survival was 38% with endovascular revascularization; 40% with surgical revascularization; and 23% among patients who underwent major amputation.

Annual health care costs during follow-up were $49,700 for endovascular revascularization, $49,200 for surgical revascularization, and $55,700 for amputation.

In the AHA announcement, Dr. Mustapha commented, “Many patients who are diagnosed with CLI are told amputation is their only option. But amputation is associated with many poor outcomes, including shorter survival, depression, and loss of independence.” He added, “It's important that people know that amputation is not the only solution, so always get a second opinion.”

In an accompanying editorial in Journal of the American Heart Association, Stephen Waldo, MD, and Javier Valle, MD, stated, “These data demonstrate the significant clinical and financial burden that CLI poses to our health care system. Considerable efforts are still needed to raise disease awareness and establish data that can guide further medical and procedural management given the critical importance of limb ischemia.”