A national survey of disease-specific knowledge in patients with an abdominal aortic aneurysm

OBJECTIVE: Patient education is a fundamental responsibility of medical providers caring for patients with abdominal aortic aneurysms (AAA). We sought to evaluate and quantify AAA-specific knowledge in patients under AAA surveillance and in patients who have undergone AAA repair. METHODS: In 2013, 1373 patients from 6 U.S. institutions were mailed an AAA-specific quality of life and knowledge survey. Of these patients, 1008 (73%) returned completed surveys for analysis. The knowledge domain of the survey consisted of nine questions. An AAA knowledge score was calculated for each patient based on the proportion of questions answered correctly. The score was then compared according to sex, race, and education level. Surveillance and repaired patients were also compared. RESULTS: Among 1008 survey respondents, 351 were under AAA surveillance and 657 had AAA repair (endovascular repair, 414; open, 179; unknown, 64). The majority of patients (85%) reported that their doctor\u27s office was their most important source of AAA information. The Internet and other written materials were each reported as the most important source of information 5% of the time with other patients reported 2% of the time. The mean AAA knowledge score was 47% (range 0%-100%; standard deviation, 23%) with a broad variation in percentage correct between questions. Thirty-two percent of respondents did not know that larger AAA size increases rupture risk, and 64% did not know that AAA runs in families. Only 15% of patients answered six or more of the nine questions correctly, and 23% of patients answered two or fewer questions correctly. AAA knowledge was significantly greater in men compared with women, whites compared with nonwhites, high school graduates compared with nongraduates, and surveillance compared with repaired patients. CONCLUSIONS: In a national survey of AAA-specific knowledge, patients demonstrated poor understanding of their condition. This may contribute to anxiety and uninformed decision making. The need for increased focus on education by vascular providers is a substantial unmet need

Association of Sex With the Use and Outcomes of Carotid Revascularization: A Cohort Study

Background Stroke is a leading cause of death that disproportionately affects women. Treating carotid stenosis with carotid artery stenting (CAS) or carotid endarterectomy (CEA) can prevent ischemic stroke. Yet, the sex‐specific use and long‐term outcomes of these interventions remain unclear. Thus, we sought to investigate sex‐based differences in the treatment and outcomes of carotid stenosis. Methods We analyzed carotid revascularizations in the Vascular Quality Initiative, a national clinical registry. Patients were linked to Medicare claims to identify long‐term outcomes. Our study cohort included patients undergoing index CAS or CEA between 2005 and 2015 who were fee‐for‐service Medicare beneficiaries aged 65+. The primary exposure was sex, and the primary outcome was stroke. Using log‐binomial regression, we estimated the relative risk for CAS treatment accounting for clustering by center. Cox proportional hazards regression was used to estimate the hazard ratio for stroke. We used inverse probability‐weighted risk adjustment based on patient demographics, comorbidities, and disease severity for all analyses. Results In our cohort of 22 341 eligible patients, 39% were women, 13% underwent CAS, and the median survival time was 2.6 years (interquartile range: 1.0–3.4 years). After risk adjustment, women were less likely to undergo CAS than men (adjusted relative risk, 0.89; [95% CI, 0.83–0.96]; P=0.003). Women undergoing carotid revascularization had a 24% increased risk of stroke (adjusted HR, 1.24; [95% CI, 1.10–1.39]; P=0.001) within 5 years of surgery. The higher stroke rate in women was noted following both carotid endarterectomy (adjusted HR, 1.22; [95% CI, 1.07–1.38]; P=0.003) and CAS (adjusted HR, 1.40; [95% CI, 1.06–1.83]; P=0.014). This effect was most pronounced for symptomatic treatment, where women undergoing CEA had a 3% higher risk‐adjusted 5‐year cumulative incidence of stroke (13% versus 10%, Gray's P=0.002). Conclusion Compared with men, women had a higher incidence of postoperative stroke after carotid revascularization, regardless of treatment type. Sex disparities in postrevascularization stroke rates may give rise to concern given the widespread use of revascularization for managing carotid stenosis

Statin therapy after infrainguinal bypass surgery for critical limb ischemia is associated with improved 5-year survival

OBJECTIVE: Although statin therapy has been linked to fewer short-term complications after infrainguinal bypass, its effect on long-term survival remains unclear. We therefore examined associations between statin use and long-term mortality, graft occlusion, and amputation after infrainguinal bypass. METHODS: We used the Vascular Study Group of New England registry to study 2067 patients (71% male; mean age, 67 +/- 11 years; 67% with critical limb ischemia [CLI]) who underwent infrainguinal bypass from 2003 to 2011. Of these, 1537 (74%) were on statins perioperatively and at 1-year follow-up, and 530 received no statin. We examined crude, adjusted, and propensity-matched rates of 5-year surviva1, 1-year amputation, graft occlusion, and perioperative myocardial infarction. RESULTS: Patients taking statins at the time of surgery and at the 1-year follow-up were more likely to have coronary disease (38% vs 22%; P \u3c .001), diabetes (51% vs 36%; P \u3c .001), hypertension (89% vs 77%; P \u3c .001), and prior revascularization procedures (50% vs 38%; P \u3c .001). Despite higher comorbidity burdens, long-term survival was better for patients taking statins in crude (risk ratio [RR], 0.7; P \u3c .001), adjusted (hazard ratio, 0.7; P = .001), and propensity-matched analyses (hazard ratio, 0.7; P = .03). In subgroup analysis, a survival advantage was evident in patients on statins with CLI (5-year survival rate, 63% vs 54%; log-rank, P = .01) but not claudication (5-year survival rate, 84% vs 80%; log-rank, P = .59). Statin therapy was not associated with 1-year rates of major amputation (12% vs 11%; P = .84) or graft occlusion (20% vs 18%; P = .58) in CLI patients. Perioperative myocardial infarction occurred more frequently in patients on a statin in crude analysis (RR, 2.2; P = .01) but not in the matched cohort (RR, 1.9; P = .17). CONCLUSIONS: Statin therapy is associated with a 5-year survival benefit after infrainguinal bypass in patients with CLI. However, 1-year limb-related outcomes were not influenced by statin use in our large observational cohort of patients undergoing revascularization in New England. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved