Mortality and patient-centered outcomes are worse in patients with dementia undergoing revascularization for claudication.

OBJECTIVE

The aims of this study were to describe mortality and patient-centered outcomes in a large cohort of patients with claudication and Alzheimer's disease and related dementias (ADRD) as stratified by treatment type. Claudication and ADRD often coexist owing to shared risk factors. Treatment for claudication is primarily conservative, although revascularization can be considered with quality-of-life-limiting leg symptoms. Mortality risk and patient-centered outcomes in patients with ADRD and claudication have not been described.

METHODS

Patients in the OneFlorida+ dataset with and without ADRD treated for claudication from January 1, 2017, to January 31, 2024, were included. The total cohort was separated into three treatment groups: medical therapy, endovascular revascularization, or open revascularization. Cox proportional hazard modeling was used for the impact of ADRD on all-cause mortality in the total cohort. Among patients undergoing endovascular or open revascularization, clinical outcomes were inpatient complications and 90-day readmissions, and patient-centered outcomes were discharge to higher level of care and discharge home.

RESULTS

The total cohort for claudication was 297,060 patients and included 27,621 patients (9.3%) with a diagnosis of ADRD. Patients with ADRD were more likely to be older (78.6 years vs 66.1 years; P < .001) and women (54.9% vs 48.9%; P < .001). For the total cohort, all-cause mortality was higher in patients with ADRD regardless of treatment type (hazard ratio, 1.1; 95% confidence interval [CI], 1.05-1.12). For patients who underwent revascularization, patients with ADRD had similar rates of inpatient complications compared with patients without ADRD (odds ratio [OR], 0.85; 95% CI, 0.72-1.01), but had higher rates of 90-day readmissions (OR, 1.9; 95% CI, 1.60-2.15). Patients with ADRD undergoing revascularization were more likely to be discharged to a higher level of care (OR, 2.1; 95% CI, 1.67-2.73) and less likely to be discharged home (OR, 0.54; 95% CI, 0.46-0.64).

CONCLUSIONS

In a large cohort of patients with claudication, patients with ADRD demonstrate a higher risk of all-cause mortality. Among patients who undergo revascularization for claudication, patients with ADRD have worse readmission rates and are more often discharged to higher levels of care, regardless of revascularization strategy. These data should be used by patients, their families, and physicians to facilitate shared decision--making conversations before claudication treatment.